A STYLISTICS ANALYSIS OF HEALTHCARE COMMUNICATION DISCOURSES ON
BILLBOARDS AND POSTERS IN WINDHOEK
A THESIS SUBMITTED IN PARTIAL FULFILMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS IN ENGLISH STUDIES
OF
THE UNIVERSITY OF NAMIBIA
BY
Angelina U. Nashipeta
201208478
April 2019
Supervisor: Dr. R. Makamani
Co- supervisor: Ms S. Ashikuti
ABSTRACT
This thesis was a stylistics analysis of healthcare communication discourses on billboards and posters in Windhoek. The main aim of the study was to examine how the language used in healthcare communication messages on posters and billboards, is packaged to persuade readers/consumers to adopt good health practices. The study also concentrated on how the
AIDA (attention, interest, desire and action) principle of advertisement and foregrounding features used in healthcare communication massages contribute to the transformation of the readers’ mind and convince them to take the required necessary actions. The researcher used a qualitative approach since the study did a content analysis to examine why the writers in selected messages used the words they used to persuade readers about certain health issues.
The analysis also focussed on what makes the selected texts persuasive using different stylistic techniques such as graphological deviation, parallelism and the AIDA principle of advertisement. A desktop study was utilised to analyse the discourse and to establish whether the messages and images, as well as where they appear (the whole poster or billboard including the background) address the aspect of persuasion and whether they reflect the AIDA principle of advertisement. The researcher utilised purposive sampling to choose seven billboards and seven posters. The researcher used the stylistics theory from a linguistic perspective. This theory was used as it highlights mostly the style used in the language in texts, and it explores creativity in language use. The major findings of the study were that writers of healthcare communication messages achieve persuasion through the use of pleasant words such as adjectives, personal pronouns, comparatives, superlatives, repetition, using pictures with attractive colors and other eye catching visuals. Persuasion is also achieved through brevity as messages are crafted as brief as possible to save the reader’s time. The study has drawn conclusions that all the words that healthcare communication text designers use when composing their texts are vital in persuading readers and getting the message across. However,
i some words are more important than others in that they contribute more on convincing readers.
These are the type of words which add more value and contribute towards the decision making process of the consumers. The AIDA principle together with foregrounding (graphological deviation and parallelism) contributes more on the transformation of minds.
ii
ACKNOWLEDGEMENT
First and foremost I would like to thank the almighty God, who provided me with wisdom, good health and all I needed to finish writing this thesis. This thesis is a product of combined efforts from many people who supported me in various ways.
I would like to express my profound gratitude to Dr. Rewai Makamani for his excellent supervision and good guidance throughout this academic program. The same gratitude goes to my co-supervisor Ms Selma Ashikuti. I will be indebted if I don’t give my heartfelt thanks to
Dr Nelson Mlambo for his constant words of encouragement and for the countless support he has offered me throughout my studies. Dr I cannot thank you enough.
My sincere gratitude also goes to my parents: Mrs Angelina Shoopala Nashipeta and Mr Jasper
J. Nashipeta and my cousin Mrs Reonol T. Shinana for their tireless efforts in rendering me all the support. The same gratitude goes to my best friend Mathew Kalimbo for his constant support and continued encouragement even in circumstances where I felt like I was doubting my abilities. I would like to thank my son Joseph Kalimbo for the patience during my studies.
I would also like to express my deepest gratitude to my sister Annely Nashipeta and my friend
Mirjam Mweulunda for all the effort they made to make certain that this thesis is a success. A special thanks also go to my friends Sussana Iipinge and Penelope Midzi for walking this academic path with me.
iii
DEDICATION
This thesis is dedicated to my lovely son Joseph Kalimbo.
iv
DECLARATION
I declare that this study is my original work. I have not previously in its entirety or in part submitted it for obtaining any qualification in any other institution of higher learning. No part of this thesis may be reproduced, stored in any other retrieval system, or transmitted in any form, or by any means (e.g. electronic, mechanical, photocopying or otherwise) without prior permission of the author, or the University of Namibia in that behalf. Where I used other people’s ideas I have referenced them as such.
Signature…………………………………….. Date…………………………………….
v
TABLE OF CONTENTS
Contents ABSTRACT ...... i ACKNOWLEDGEMENT ...... iii DEDICATION ...... iv DECLARATION ...... v TABLE OF CONTENTS ...... vi CHAPTER 1 ...... 1 INTRODUCTION ...... 1 1.0 Introduction ...... 1 1.1 Background of the study ...... 1 1.2 Statement of the problem...... 2 1.3 Research objectives ...... 4 1.4 Significance of the study ...... 4 1.5 Limitation of the study...... 5 1.6 Delimitation of the study...... 5 1.7 Organization of the study ...... 5 CHAPTER 2 ...... 6 LITERATURE REVIEW AND THEORETICAL FRAMEWORK ...... 6 2.0 Introduction ...... 6 2.1 The Stylistics analysis theory ...... 6 2.2 Defining healthcare communication ...... 9 2.3 Health communication language ...... 12 2.4 Stylistic principles used in health communication ...... 14 2.4.1 The AIDA principle of advertisement ...... 14 2.4.2 Style ...... 15 2.4.3 Foregrounding...... 16 2.4.3.1 Graphological foregrounding ...... 17 2.5 Affective stylistics ...... 18 2.6 The target audience...... 19 2.7 Illustrations and images ...... 20 2.8 Factors that affect persuasion in health care messages...... 21 2.9 What entails an effective health massage? ...... 21 2.10 Persuasion focused semantics ...... 22 2.11 Linking messages to pictures or visual images ...... 24 2.12 Summary ...... 26
vi
CHAPTER 3 ...... 27 RESEARCH METHODS ...... 27 3.0 Introduction ...... 27 3.1 Research design...... 27 3.2 Population ...... 28 3.3 Sample ...... 28 3.4 Research instruments ...... 29 3.5 Procedure ...... 29 3.6 Data analysis ...... 29 3.7 Research ethics ...... 31 3.8 Summary ...... 31 CHAPTER 4 ...... 33 DATA ANALYSIS AND PRESENTATION ...... 33 4.0 Introduction ...... 33 4.1 Data analysis ...... 33 4.1.1 Message alongside visuals/ pictures ...... 34 4.1.2 Persuasion via the AIDA principle ...... 35 4.1.4 Persuasive words used ...... 36 4.1.5 Use of colour ...... 37 4.1.6 Graphological deviation ...... 37 4.1.7 The use of repetition ...... 38 4.1.8 Persuasion strategy ...... 39 4.1.9 Powerful words and visuals ...... 39 4.2 Reflection of the AIDA principle ...... 40 4.2.1 Violation of graphological deviation ...... 41 4.2.2 Persuasion tactic ...... 42 4.2.3 Chosen words ...... 43 4.2.5 Parallelism ...... 45 4.2.6 The outline of the billboard ...... 46 4.2.7 Choice of words ...... 46 4.2.8 How images and visuals contribute to transformation of minds ...... 47 4.2.9 Persuasiveness through the AIDA principle ...... 47 4.3. Persuasive aspects in the text itself ...... 49 4. 3.1 Reflection of the AIDA principle ...... 49 4.3.2 Images and visuals used ...... 50 3.3.2.1 The presence of affective stylistics ...... 50
vii
4.3.3 Foregrounding...... 51 4.3.3.1 The presence of graphological deviation ...... 51 4.3.4 Captivating words used ...... 52 4.3.5 The AIDA principle and graphological deviation ...... 53 4.4 Where the billboard appears ...... 54 4.4.1 Significance of the AIDA principle in the text ...... 55 4.4.2 Persuading words and graphology employed in the text ...... 55 4.4.2.1 Repetition on the billboard ...... 56 4.5 Persuasive words used ...... 57 4.5.1 The AIDA principle of advertisement ...... 57 4.5.2 Affective stylistics in the text ...... 58 4.5.3 Graphological deviation in the message ...... 58 4.5.4 The entire poster ...... 59 4.5.4 The AIDA principle ...... 59 4.5.5 Graphology verses persuasion ...... 60 4.6 Poster outline ...... 61 4.6.1 Words, visuals and images used ...... 62 4.6.2 AIDA principle and health communication ...... 64 4.6.3 Foregrounding in the message ...... 64 4.6.3.1 Graphological deviation ...... 64 4.6.3.2 Rational of dialectical deviation ...... 65 4.6.3.3 Parallelism in the text...... 66 4.6.4 Outline of the entire poster ...... 67 4.6.5 Captivating words used ...... 68 4.6.6 AIDA and graphology ...... 69 4.6.7 Persuasive words ...... 70 4.6.8 The AIDA principle ...... 72 4.6.9 Graphology ...... 72 4.7 Layout ...... 73 4.7.1 Persuassive words used ...... 74 4.7.2 AIDA ...... 74 4.7.3 Foregrounding...... 75 4.7.3 Persuasion ...... 75 4.8 Persuasive words and images ...... 76 4.8.1 The AIDA principle of advertisement ...... 77 4.8.2.1 Repetition ...... 78
viii
CHAPTER 5 ...... 79 DISCUSSION AND CONCLUSION ...... 79 5.1 Introduction ...... 79 5.2 Persuasive words and visuals used in the discourses ...... 79 5.3 The use of the AIDA principle in healthcare communication discourses ...... 80 5.4 How foregrounding was used in healthcare communication discourses ...... 81 5.5 Words pertaining affective stylistics...... 81 5.6 Conclusion ...... 81 5.7 Recommendations ...... 84 REFERENCES ...... 85
ix
CHAPTER 1
INTRODUCTION
1.0 Introduction
This research was a stylistics analysis of health communication discourses on billboards and posters in Windhoek. The purpose of the study was to examine how the language used in the chosen means of healthcare communication namely, posters and billboards, was crafted to persuade readers. The study focused on how the AIDA (attention, interest, desire and action) principle of advertisement and foregrounding used in the massages influence perceptions of the target audience.
1.1 Background of the study
The language that is used in any form of promotion in general, often does more than just informing the public about services and products that are on offer. The language usually has an extra essential task of aiming to persuade potential consumers to accept, or buy, whatever healthcare service or products that are on offer. The query one would have in mind is the type of words billboards/ posters designers use to achieve their desired goals.
Ratzan (1994) defines health communication as an art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues (p.
14). Interest in healthcare communication inside and outside the field of communication has grown over the past two decades. Ratzan (1994) further explains that the mass media are intensively employed in public health. Vast sums are spent annually for materials and salaries that have gone into the production and distribution of booklets, placards, pamphlets, newspapers, radio and television programs. These media are employed at all levels of public health in the hope that three effects might occur: the learning of correct health information and
1 knowledge, the changing of health attitudes and values and the establishment of new health behavior (Ratzan, 1994).
Parrott (1999) maintains that the range of goals for healthcare communication comprises of disease prevention, health promotion, healthcare policies, and the business of healthcare as well as enhancement of the quality of life and health of individuals within the community. In each occasion of healthcare communication, there must be careful selection of appropriate channel in order for message(s) to reach the target addressees.
Anthonissen and Meyer (2008) have noted that effective verbal communication is a prerequisite for effective treatment. Although there are currently no studies that support the idea that the messages on posters, billboards and other sources containing printed healthcare messages are as important as patient physician communication, healthcare discourses should have persuasion as one of its goals. In each instance of health communication, there must be careful deliberation concerning the appropriate channel for messages to best reach the target audience, ranging from face-to-face interactions to television, internet, and other forms of mass media such as posters and billboards.
1.2 Statement of the problem
This study pursued a stylistic analysis of health communication messages used on both posters and billboards in Windhoek. Even though research has been conducted on effective verbal health communication, Anthonissen and Meyer (2008) indicate that very few studies have been conducted on the messages themselves that are used in the healthcare sector. According to the literature reviewed in Namibia, no one has conducted a study of this nature before. Therefore, there is a gap in health communication studies, that is, how exactly health texts are written.
2
Moreover, many researchers in African countries researched on physician and patient communication (see also Sobane and Anthonissen 2013; Sobane 2012; Makamani 2017;
Mlambo 2017) but not on the texts used in healthcare communication, especially in healthcare promotion messages found on the printed media, let alone posters and billboards. The study did a stylistic analysis of the texts used on posters and billboards to raise health awareness to the public in Windhoek, Namibia. It investigated how the words in selected texts and visuals are chosen and arranged to have persuasive effects on the consumer. In addition, this study also investigated how the AIDA principle is employed in healthcare communication discourses in terms of how the words are made to speak to the visuals on the poster or billboard and how the entire text reflects the AIDA principle. The study also analysed the discourse used in the message by identifying the register. This study provides an agenda for future research and extends theory in healthcare communication.
A growing body of research in South Africa has shown the ineffectiveness of communication across cultural and linguistic barriers, the many facets to cross-linguistic and cross-cultural communication, the pitfalls involved in using interpreters, and the need for further research in this area (Penn, 2007).
It was evident from all the literature presented in this section that the use of distinctive style in healthcare messages or texts remains important as a strategy to appeal to readers and/or consumers. This is manifest even though the scholars have explored style from different perspectives. It is worth observing that the rapid growth of the internet and social media has considerably reduced the use of print adverts such as posters and billboards that are used in the healthcare sector. However, the inevitable truth is that print mass media still upholds its stance as a powerful and necessary medium in health promotion and also in other disciplines. As a result, this research hopes to discuss the persuasive abilities of healthcare discourses by using
3 a stylistic approach. More importantly, this research presents a newer dimension by bringing together most of the stylistic aspects used in making health texts persuasive.
Even though works have been done using stylistics, only few of these works have focused specifically on messages that are used in healthcare discourses, let alone exploring the stylistic aspects used in the messages to enhance persuasion.
1.3 Research objectives
The objectives of the study are to:
examine how the designed messages (words) and visuals used in the selected healthcare
communication reflect the aspect of persuasion;
analyse how the AIDA (attention, interest, desire and action) principle of advertisement
is employed in healthcare communication discourses in order to make sure that the
massage changes, or leads to, specific behaviour in people; and,
discuss how foregrounding is used in the massages and how it contributes to the
transformation of minds.
1.4 Significance of the study
Findings from this study will contribute to the limited existing body of knowledge since no one has done a study on the texts used in healthcare communication in Namibia. The study, therefore, sought to fill this gap as no one has done a study focusing on analysing the linguistic styles used in healthcare messages on posters and billboards in healthcare promotion messages before. The findings might also lead to follow up research since the study also sought to raise awareness on how the English language is used in the health sector to create awareness on various healthcare issues. Future researchers, especially those whose studies revolve around healthcare or communication, might use this study as reference.
4
1.5 Limitation of the study
This study is confined to stylistic analysis of healthcare communication used in billboards and posters. Any other form of healthcare communication as well as posters and billboards written in other languages are beyond the boundaries of this study, hence, the findings resulting from this study cannot be generalised to the above-mentioned matters or forms of healthcare communication.
1.6 Delimitation of the study
There is a plethora of literature on health communication studies, but the fact that this research only focused on billboards, posters that are in Windhoek specifically is sufficient as for this study.
1.7 Organization of the study
This study is structured in the following manner and contains the following: The first chapter introduces the study and consists of the background of the study, statement of the problem, research objectives, significance of the study, limitations and the delimitation of the study. The second chapter explains the theoretical framework that the study used and reviews the literature. Chapter 3 presents and clarifies the research methodology aspects, and introduces the design used for the study. Chapter four is on data presentation and discussion, while the last chapter presents the recommendations and conclusions of the study.
5
CHAPTER 2
LITERATURE REVIEW AND THEORETICAL FRAMEWORK
2.0 Introduction
This chapter commences with explaining the theoretical framework. It also reviews the available literature that is prominent to an analysis of healthcare communication discourses in order to identify gaps in knowledge in the existing literature. The chapter discussed how the discourse used in posters and billboards is made to have a persuasive effect on the desired audience and how it reflects the AIDA principle of advertising, which in this case is applied to health promotion. It is in this chapter where the research objectives were explored in detail. It also gave an insight of related literature on the discourse used in advertisements studies conducted to provide sufficient information to the researcher.
2.1 The Stylistics analysis theory
First and foremost, the study made use of the Stylistics Theory. This theory highlights mostly the style used in the language in texts and it explores creativity in language use (Simpson, 2004, p.4). The study looked at the stylistics theory from a linguistic perspective. The study attempted to demonstrate how the stylistics principles such as persuasion, style, the AIDA principle of advertisement, affective stylistics and foregrounding are used to compose texts used in health communication printed media such as posters and billboards respectively.
Therefore, the stylistics theory was used to show how words are chosen and arranged so that they have persuasive effect on the reader.
Similarly, stylistics, in the words of Simpson (2004, p.4) is defined as a method of textual interpretation in which the primacy of place is assigned to language. Simpson acknowledges that utterances (literary or otherwise) are produced in a time, a place, and in a cultural and
6 cognitive context. In other words, this means that any existing text is meant for a particular context at a specific time and place. He further acknowledges that stylistics looks at language as a function of texts in context. Hence, a knowledge of stylistics will enable one to look at any given text with a critical mind, as opposed to only a consuming mind.
Moreover, stylistics is the description and analysis of the variability of linguistic forms in actual language use. Stylistics in linguistics refers to the identification of patterns of usage in speech and writing (the focus point of this study). It is the study of the ways in which meaning is created through language in literature as well as in other types of text (Smit, 2012). Stylistics seeks to understand what the possibilities are in a given language and asks why particular choices are made - for example, in a health promotion poster, ‘bias’ can simply be in the stylistic choices themselves. It is sometimes felt that there is a need to provide people with analytical tools which enable them to understand the stylistic mechanisms by which ideas are communicated.
Wales (2011, p.453) notes that:
the goal of most stylisticians is not simply to describe the formal features of texts for
their own sake, but to show their functional significance for the interpretation of the
text; or in order to relate literary effects to linguistic 'causes' where these are felt to be
relevant.
In a similar manner, this view is supported by Rewal (2013) who maintains that stylistics is concerned with the analysis and description of the linguistic features of texts in relation to their meaning. Stylistics is a branch of linguistics which studies the principles, and effect of choice and usage of different language elements in rendering thought and emotion under different conditions of communication. It is clear from these definitions that stylistics deals with expressive and functional styles of language use.
7
As a branch of linguistics, stylistics studies the understanding of texts with regard to their linguistic style by linking literary criticism to linguistics. It is the description and analysis of a variety of linguistic forms in actual language use. The study of stylistics revolves on the mutual theory that within the language system, the same content can be determined by more than one linguistic form. The uniqueness and individuality in which healthcare communication messages are set becomes of high interest to the researcher since it is inadequately researched in African countries, including Namibia.
So often, stylistics scholars use linguistic models, theories and frameworks as their analytical tools in order to explain how and why a text functions as it does and how meaning is conveyed.
The analysis typically focusses qualitatively, or quantitatively, on the phonological, lexical, grammatical, semantic, pragmatic or discoursal features of a text. Texts include advertising, academic writing, news reports as well as non-printed forms such as TV, and pictorial advertising, film and multimodial publications (Smit, 2012).
As Wales (1980, p.269) puts it, stylistics actually slows down the reading process. By so doing, one is triggered to replace the question “what does this text or sentence mean?” with “what does it do?” Wales (1980, p.273) is also of the opinion that the text’s meaning is changed as it is experienced through reading, as a reader becomes part of the text.
On the other hand, a knowledge of stylistics, as Smit (2012) puts it, enables one to see deeper not only in works of literature but also in various forms of writing such as texts. It is through stylistics principles that one’s mind is sharpened to be as critical as possible
In this study, the texts on selected healthcare communication posters and billboards were analysed using the different stylistics principles to come to a conclusion as to what unique features are in these texts that persuade people to change behaviours, or perceptions, towards what is addressed in a particular poster/ billboard which makes one react to it.
8
2.2 Defining healthcare communication
Firstly, the term communication has been defined by Oyewo (2000, p.157) as “the process of transmitting, receiving and acting upon messages, thoughts, ideas, attitudes, and feelings through mutually agreed determined codes/symbols”. In the field of healthcare, communication is regarded as the process where information is distributed for healthcare delivery and to promote public health (Kreps et al., 1998). To promote health, information is distributed to a broad target audience.
Secondly, health Promotion has been defined by the World Health Organization's (WHO) 2005
Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health". Another similar definition of health communication is that of Ratzan (1994, p.362) who delineates it as the art and technique of informing, influencing, and motivating individual, institutional, and public audiences about important health issues. The scope of healthcare communication includes disease prevention, health promotion, health care policy, and the business of healthcare as well as enhancement of the quality of life and health of individuals within the community. All these definitions have one key point of informing people about certain health issues through the process of communication.
By looking at the previous definitions, Ratzan’s (1994) definition covers much ground of what has not been mentioned by the WHO (2005), by stating that apart from it being an art of informing the public, it is a way of influencing, and motivating people to adopt health behaviours. Ratzan’s (1994) definition addresses the shortcomings in the WHO (2005) definition.
Thirdly, within the health setting, people have to partake in the choices that affect their health, however matters of language and literateness need to be well-thought-out. Health literateness,
9 which refers to the ability to gain, process and understand health information, is a vital portion of health communication and health promotion.
According to Sindano (2014, p.13), “a creative and skilful use of language is of paramount significance; the focus is on using the language to excite and amuse the consumers or consumers”. Sindano’s conclusions are similar to that of Ray (2015, p.75) who asserts that language has become a communication tool which influences consumers' attitudes towards products, companies, brand names, life styles and the public.
As Ekanjume (2012) puts it:
Success of transmission of the message depends on two factors – content and context.
Content is the actual words or symbols that constitutes a part of the message, known as
language. It could be either spoken or written. People interpret words in their own ways,
so much so that even simple messages could be understand differently. Context on the
other hand is a way the message delivered using extra linguistic features-the tone,
expression in the sender’s eyes, body language, hand gestures and state of emotion
(anger, fear, uncertainty, confidence and so on). Since people believe what they see
more than what they hear, they truest the accuracy of nonverbal behaviour more than
verbal behaviour. So, when they communicate, the other person notices two things,
what they say and how they say it (p. 132).
Although nice words and well-established grammar matter, when it comes to communication, it is very much important to know which words to use when communicating to who. Have the people you want to communicate to before you come up with the message. In other words, a speaker, or a communicator’s health message, should create no room for misunderstanding.
10
Moreover, health conscious consumers are, all the time, more proactive in seeking information regarding their wellbeing, that is, health-wise. So often people don’t just want, but need information pertaining to disease prevention and other medical problems, as well as information regarding their entire health. Basically, the health ministry, and other related organisations alongside the public, share an interest in promoting and nourishing informed decisions for better health. With this, one can clearly see the prominence of conducting a study on health communication, which looks at how the messages are written to persuade people to own their health. However, it is still vital to do various research on different health communication aspects such as what determines where (location) these posters and billboards should be placed, as this area remains unexplored.
The study by the Agency for Health Care Policy and Research (1997) reveals that the tendency of rapidly expanding opportunities in health communication intersects with recent demands for more rigorous evaluation of all aspects of the healthcare and public health delivery systems and for evidence-based practices. Numerous studies of provider-patient communication support the connection among the quality of the provider-patient interaction, patient behaviour, and health outcomes. Based on this evidence and other literature reviewed, it came to the researcher’s attention that most researchers were interested in analysing the communication between patients and doctors (health providers), but no one conducted a study that analysed the messages that are used on posters and billboards. Therefore, this study will add to the limited body of knowledge in health communication studies. As the knowledge base about provider-patient interactions increases, a need becomes more apparent for researchers to do various research that will contribute to the wellbeing of Namibian people and the African continent at large. Researchers need to explore deeper into the area of health communication without tackling just one issue. One area that still remains to be investigated is the role of health information and for who it is meant.
11
The Extended Parallel Process Model (EPPM) is the most recent fear appeal theory that attempts to explain when and why these persuasive messages may work or fail (Witte & morrison, 1995). In their modified version of the EEPM, Witte and Morrison (1995) suggested that health communication messages “should emphasize low barriers, high efficacy, and moderate levels of threat” (p. 245). They insightfully concluded that “great healers are also great communicators” (p. 246). “Great healers also know how to motivate patients. They frame messages in a way that achieves acceptance and adherence” (p. 246). Thus, understanding and motivation are key attributes of medical providers who could be considered competent.
Finally, health literacy is essential for giving voice to consumers and allowing them to partake in health matters. Kanj and Mitic (2009, p. 4) view health literacy as an empowerment tool for promoting active citizenship. They maintain that health literacy is achieved when individuals understand their rights as patients, including being able to navigate the healthcare system, and by actively participating as informed members (Kanj & Mitic, 2009). Health literacy is required for participation in the healthcare system and for people to understand their treatment options and decisions. Participation and voice in healthcare are important as they are the way towards encouraging health citizenship by empowering consumers to become involved in knowing their health risks and improving their health in general.
2.3 Health communication language
Kangira (2009, p. 39) reveals that:
The language that is used in the commercial advertisements in general often does more
than just inform the public about products that are on sale; the language usually has an
extra crucial task of trying to persuade potential customers to buy the products.
12
Kangira (2009) further points out that service-oriented persuasive communication is intended at influencing people’s minds so that they end up using the service, or product, that is being promoted. Such actions are executed often without taking the rationale of such actions into consideration.
The language depicted in health messages on both posters and billboards is also believed to play a significant role in the understanding of the entire message by a reader. It is evident from advertisement techniques that health communication message designers have a way of making their messages persuasive.
Moreover, there is a gap in the available literature in that Nieuwenhuizen (2012) only analysed communication strategy in terms of how diction is used in advertisement but not in health communication discourses, and it plays a significant role in persuading consumers. A creative and skilful use of language is of paramount significance; the focus is on using the language to excite and amuse the consumer. Therefore, this study intended to extend these frontiers of knowledge as it investigated the language used in communication as a persuasion strategy from a different perspective, which is health communication.
The milieu for communicating about health-related issues has improved significantly over the years (Neeuwenhuizen, 2012). These improvements include dramatic increases in the number of communication channels and the number of health issues contesting for public attention as well as consumer demands for more and better quality health information, and the increased sophistication of marketing and sales techniques, such as direct-to-consumer advertising of prescription drugs and sales of medical devices and medications over the internet. The expansion of communication channels and health issues on the public agenda increases competition for people’s time and attention; at the same time, people have more opportunities to select information based on their personal interests and references (Nieuwenhuizen, 2012).
13
An audience-cantered perspective also reflects the realities of people’s everyday lives and their current practices, attitudes and beliefs, and lifestyles. Some specific audience characteristics that are relevant include gender, age, education and income levels, ethnicity, sexual orientation, cultural beliefs and values, primary language(s), and physical and mental functioning.
Additional considerations include their experience with the health care system, attitudes toward different types of health problems, and willingness to use certain types of health services.
Particular attention should be paid to the needs of underserved audience members.
2.4 Stylistic principles used in health communication
2.4.1 The AIDA principle of advertisement
The AIDA model in advertisement is an acronym that is used by advertisers to create good and successful advertisements of a particular product for the intended audience or potential buyers.
In fact, AIDA stands for Attention (grab the viewer’s attention), Interest (create interest in the product), Desire (desire for the product), and Action (buy the product or enquire more about it) (Rawal, 2013). Gath (2006) argues that the design of different advertisements ought to obey the AIDA principle of advertising. In the same manner, health promotion messages have to as well follow the AIDA principle of advertisement since they function just like adverts. For instance, an extremely long message on a health promotion poster is likely to be ignored by most people coming across it, especially with the fact that Namibians are believed to have a poor reading culture. Due to this reason, text designers try by all means to make their texts as catchy, short and interesting as possible to win the attention of any person passing by.
Goddard (1998, p.31) views advertising as the science of arresting the human intelligence long enough to get money or attention from it. She found that a relationship exists between language and images used in advertisements and culture, and between the advertiser and the buyer.
14
Similarly, linguists all over the world have researched advertising language in its different aspects.
Subsequently, conclusions according to Goddard (1998, p.125) are that, advertising language is diverse, whether it is formal or not, much depends on the subjects addressed in the advertisements. In addition to that, advertising language is highly impressive or persuasive to obtain the main purpose of advertising that is to seek the attention of potential customers’.
Advertising language exists in a close relationship with other elements of advertisements to make it successful.
Health promotion is similar to advertising, the only distinction is that adverts’ aims are to increase sales while health communications only aims at increasing sales sometimes. It mainly aims at persuading the public to adopt/ change certain behaviours that are perceived to be appropriate and healthy. Hence, the language used in both bears similar features. In health communication, it is not what you say that matters, but rather how you say it.
2.4.2 Style
Actually, style is the way the text is written. It can be seen as the conscious/ unconscious selection of a set of linguistic form from all the possibilities in a language. The effects of these features can only be understood by intuitively sensing the choices that have been made. Leech and Short (1981, p.11) define style as the way language is used by a given person in a given context for a given purpose. In other words, style is by no means restricted to the style of a particular author, but can be a characteristic of a situation, a character, a particular text, a particular linguistic expression that is investigated over time and so on. It is a particular way of writing or speaking. Register resembles style as well because it refers to the particular linguistic features that mark text types or situations in an interview, or political speech (Leech
& Short, 2006, p.69).
15
As a matter of fact, style, as a linguistic concept, is very flexible and dynamic undoubtedly due to its potential for diverse application. Thus, it has been a subject of different ascriptions and characterizations Azuike (2006, p.77). The concept is consequently divided into six broad theoretical sub-headings: “(1) a deviation from a norm; (2) a manifestation of the individual;
(3) content and/or form; (4) choice between alternative ways of expressing the same idea; (5) product of context; (6) and simply as good or beautiful writing (Azuike, 2006).
2.4.3 Foregrounding
According to Gregoriou (2009, p.37) foregrounding is essentially a psychological effect relating to the prominence that certain features of language achieve in contrast to the background of everyday language use. To culminate, this means that the unfamiliar features of the text that are unexpected come to the forefront of the reader’s attention against the background of its normal linguistic features. In other research deviation from linguistic or other socially accepted norms, which suggest the analogy of a figure seen against a background are labelled foregrounding (Leech, 1968, p.57). In simple words foregrounding is seen as a way in which things draw attention to themselves by standing out from the rest.
Gregoriou (2009, p.30) defines deviation as the difference between what we take to be normal or acceptable and that which is not. This leads to breaking rules or expectations in some way.
The various levels of deviation are: lexical deviation, grammatical deviation, phonological deviation, graphological deviation, semantic deviation, and dialectical deviation, deviation of register and deviation of historical period. Parallelism device, on the other hand, is defined by
Smit (2012, p.72) as the structural repetition in which variable elements occur.
Moreover, Yu (2013, p.87) articulates that lexical deviation occurs when new words are formed
(neologism); graphological deviation happens when there is capitalization, italicization, unfamiliar writing and so on. Phonological deviation is achieved for example when there are
16 frequent repetitions of the same sound and, finally, grammatical deviation comes into being when sentences are probably split resulting in making the sentence ungrammatical. Such situations are often found in healthcare communication messages and adverts. Although the language could be deviated, it still conveys meaning in a given text.
Graphological deviation appears almost in any text, be it long or short. The analysis in the present study made use of other forms of deviations but focussed more on graphological deviation.
2.4.3.1 Graphological foregrounding
This form of deviation covers a lot of ground in almost any written text. The linguistic devices such as length of the text, sentence construction, punctuations as well as the visuals that accompany the discourse play a major role of enhancing textual appeal as well as aiding the readers to capture and interpret the text in such a way that it persuades one to adopt healthy practices. It is any attention catching device in a text ranging from repetition, coupling and collocation, which makes parts of the text to stand out in a specific context, making the text prominent. So often, the features or devices that make the text or part of the text thereof stand out from the rest make the text unique and catchy.
Alternatively, in the words of Adegoju (2008, p.160) Graphology is perceived to be concerned with aspects such as spelling, CAPITALISATION, a text’s layout, hyphenation, lists, font choices, underlining, paragraphing, italization, colour that can generate various kinds of impacts, of which some can trigger different readers to act and react differently. Previous studies such as that of Ngara (1982, p.17) came up with a similar definition of graphology as he also mentioned that it dwells on the layout of the text, colour, and shape of the printed marks, punctuations, paragraphing, and spacing.
17
In addition, Yeobi (2014) echoes the similar view point when he highlights that graphology is the level of linguistic analysis that focuses on the layout of the texts the size and shape of words as well as other features contained in the text (i.e. graphical and/or orthological). The same study further clarifies that it is the initial and vital procedure of paying close attention to the whole text, including the background where the text appears, images and other visuals, symbols, graphics and anything that appears where the text is. All of these aspects aid to encode, or transform its significance. In other words, it is viewed as a paralinguistic approach to the clarification of textual understating and meaning because it pays attention specifically to the non-verbal aspects of the discourse, like arrangement and visual appearance which enhance meaning. All these aspects give a distinctive situational meaning to the text based on the social framework in which they are used.
In contrast, the definition of Ngara (1982) has some loopholes as it fails to include underlining, font choices, hyphenation, itilisation, lists as well as indentation. All the shortcomings in
Ngara’s definition were however addressed in Adegoju’s (2008) definition. However, the aspect of using bold letters is a feature of graphological deviation that the two reviewed studies failed to mention.
Graphology is basically a level of foregrounding which pays attentions on the layout of texts, the size or shape of words and any other feature that is graphical or orthographical. The definitions of graphological deviation slightly vary from scholar to scholar. The existing literature on graphology is extensive and focuses particularly on the appearance of the words on a page.
2.5 Affective stylistics
Affective stylistics focusses on the readers’ experience on a literary work. In the words of Fish
(1970, p.143), the meaning of a literary text cannot be seen as separate from the reader’s
18 experience of it. Affective stylistics is of the opinion that the text, as an independent object, disappears in their analysis and becomes what it really is. This is an experience that occurs within the reader. Their use of thematic evidence underscores the important role played by the text in establishing what the reader’s experience is. This mechanism allows us to devote semantic value to a given lexical unit according to its context.
Smit (2012) asserts that affective stylistics concentrates on patterning or format of texts and it makes no assumption of its artistic value. Through investigating the way language is manipulated in the text, stylistic can make apparent those linguistic patterns of which the person’s intuitive awareness of what artistic values are in the long run depended.
Affective stylistics aims to explain how the words of the text create the feelings and responses that readers get when they read them. Affective stylistics is also called reader response, and it is influenced by emotions. It is an analysis of how the text structures the reader’s response. The reader becomes an active part of the text; individual readers give meaning to the text because each reader will interact with the text differently, hence more than one valid interpretation.
One can conclude from Fish’s (1970) words that, any given text of any kind, including healthcare messages, arouse certain feeling in a reader, depending on how the reader views it.
As a text is read, it is at that very moment when the reader is reading that the meaning is created.
Hence one text can affect various readers differently resulting in each reader to interpret it differently. There is a relatively small body of literature that is concerned with healthcare texts, therefore this study represents the generally unexplored area of academic interest.
2.6 The target audience
The target audience is the public at large. Every person wishes to have a lifetime of absolute health and then other things follow. So, health communication targets every person, but in some
19 cases there are specific people who are targeted by particular health promotion messages in terms of gender, occupation and culture. Although some healthcare massages target some people or a group of people, in particular they affect all the Namibian people in one way or another.
2.7 Illustrations and images
Research indicates that effective health promotion and communication initiatives adopt an audience-centred perspective, which means that promotion and communication activities reflect audiences’ preferred formats, channels, and contexts (Maibach & Parrott, 1995). The use of images is one of the many tactics that advertisers employ to increase sales because images or visuals are considered to be very successful in catching the eyes of potential consumers (Salomo, 2015). In the same light, Christelle (2012) reveals that “images evoke situations and realities in our lives or encourage us to dream about things that we would like to have or do” (p. 26). Conclusions can therefore be drawn from the latter’s findings that for any printed promotion message to be persuasive enough, it must at least be accompanied by an image or two.
In health communication, despite it barely having an aim of increasing sales as opposed to commercial advertisements, many at times images are used as tools to aid persuasion. In most cases, the images that are used are not just any image but well thought of images. They can be that of renowned people (artists, soccer players, movie starts, public figures etc.) who will trigger ones’ mind to take the necessary responses. For instance, in a particular national campaign of male circumcision, a poster containing an image of a famous Namibian artist “The
Dogg” was used, and the message that was linked to the picture is “GET A SMART CUT
WITH THE DOGG”.
20
2.8 Factors that affect persuasion in health care messages.
According to Stewart (2001) many healthcare professionals believe that communication is more effective when it is responsive to patient needs, values, and preferences. Factors that influence this communication include cultural differences, low health literacy, and language differences. This means, for example, that people who value health are the ones who in most cases spot out where these health posters or billboards are, read and understand them, as the writer intended, and take necessary actions as required, as opposed to those who don’t value health because people differ when it comes to values. Whenever a poster/billboard which contains a message that is addressing one’s health needs, it is obvious in most cases that the reader will react to it by taking the required actions.
2.9 What entails an effective health massage?
Health is the central part for every human’s survival, hence it is prominent to make sure that the messages pertaining healthcare are effective. In their improved version of the Extended
Parallel Process Model, Witte and Morrison (1995) suggested that health communication messages “should emphasize low barriers, high efficacy, and moderate levels of threat” (p.
245). They insightfully concluded that “great healers are also great communicators” (p. 246).
Great doctors also know how to motivate patients. They frame messages and interpret them in a way that achieves acceptance and adherence to whatever the message is all about, and this is persuasion on its own. Thus, understanding persuasion and motivation are key elements of medical providers who could be considered competent. The proposed definition of competence, however, goes a step or two further than these conclusions. For instance, the proposed definition suggests that although a communicator might exhibit competence in one situation, that same individual could be incompetent under different circumstances. Thus, when compared to the proposed definition, Witte and Morrison (1995) appear to present a view of
21 competence that is far too static and does not account for the changing and situational nature of competence within health care settings.
In the health context, citizens have to participate in the decisions that affect their health, however issues of language and literacy need to be considered. Health literacy, which refers to the ability to obtain, process and understand health information which is an important part of health communication and health promotion. In order for health messages designers to achieve their goal of persuading readers, they must bear in mind that the language they use, their choice of words, visual images that accompany the message font size and type, background of the poster/ billboard or wherever the message appears, contributes more on the aspect persuasion. As in most health promotion posters and billboards, persuasion is the major focus. Communication implies that in order for successful negotiation of meaning to occur, communicators must effectively enact certain competence skills.
2.10 Persuasion focused semantics
Semantics is a term in linguistics that refers to the study of meaning of words. In a study on the uniqueness of the choice of words employed in the language, Emodi (2011) observes that the heart of any kind of promotion is the act of persuasion imbedded in it. In the same study, connotative meaning of words, adjectives, coined words, miss-spelt words, repetition, metaphoric use of words, punning, non-existing words and ambiguous statements, were conferred in relation to how message producers use them to achieve their ends (persuasion).
The study furthermore discussed the types of words employed in promotions as those that can influence the audience to consider a different product and also grasp the attention of the readers.
Emodi (2011) argues that the words employed by advertisers must be enticing. Emodi (2011) concluded that whether the consumer falls for the message solely lies on the wise language use
22 of the communicator. The advertiser ought to apply imaginative, original, and fresh language
(p. 325).
In her Analysis of the Linguistic Features of Billboard Advertising in Nigeria, Nnamdi-
Eruchalu (2015) made a significant point that the language of advertisement is a deliberate attempt to deploy specialized expressions for the purposes of disseminating messages within the limited time and space available. The study had assumptions that the language of advertising has its own favoured linguistic expressions through which it reaches its target audience. It is within this setting that advertisers tend to go for short smart messages which can be read at a glance. Such patterns of linguistic choices, according to her, imply the style of the language of advertising. Another study conducted by Zuliana, Tanjung and Ardi (2010) found out that language style deals with the techniques used in showing freedom of expression, comment, express ideas, feelings, and give information to people. The study by Zuliana,
Tanjung and Ardi (2010) paid attention on slang in advertisements specifically, but it also managed to provide relevant findings that can be generalized.
Nnamdi-Eruchalu (2015) also made a case for the use of adjectives in the language of advertising. She retained that adjectives are used to paint an attractive picture of the services advertised, it can be health services or any kind of service. She further notes that adjectives assist advertisers to build beauty, splendour and strength around what is being communicated so as to make the audience desire the service. She also argued that manipulation is often present in the language of persuasion. In that respect, she agrees that any type of communication is brought about by making use of the appropriate diction in order to manipulate the minds of the target audience to believe in the message. In other words, healthcare communication messages on billboards and posters are designed in a manner that the reader will always think that they are truthful and ought to be obeyed. Nnamdi-Eruchalu (2015) further argues that grammatical
23 rules are deliberately violated in an attempt to effectively achieve their communicative aim. As such, verbs (action/doing words) are deliberately omitted. She also testifies that there are morphological processes (the formation of words to be specific) which can get the attention of the audience within a short period of time.
Much greater part of the literature on health communication, which is the nucleus of this study, has emphasised the importance persuasion has been based on principles of advertising since promotion messages and adverts use similar tactics or actually the same language to grasp the attention of readers.
2.11 Linking messages to pictures or visual images
Pictures aid readers to infer the relevance of phrases that are used in advertisements. Incomplete sentences give clues to how the speaker is supposed to be related to the readers (De Lima,
2014). Several research papers have been conducted in the field of advertisement, for example, the study of Salomo (2015) who analysed the language used in insurance company’s advertisements, whereby he analysed the texts alongside the images, but there are gaps in knowledge in that no study was conducted that analysed the texts alongside the images used in health communication discourses from a stylistics point of view. Therefore, this study aims to fill up these gaps.
In most of the health communication posters and billboards, the texts printed on them are accompanied by images or visuals which play a major role in persuading the reader to believe in whatever is being said. The images on posters also help in the entire understanding of the message since there is always limited space on posters to accommodate too many words.
Mayr (2010) argues that “one attention seeking device or strategy that has been developed recently in order to increase the level of sophistication in different advertisements is the image”
24
(p. 65). Mayr (2010) further states that the manner in which some images are portrayed alongside certain texts can suggest certain ideas. Similarly, in health promotion massages images, and not just images but colourful images are used to attract the attention of any passer- by which triggers him or her to read the message and link the text content to the image(s).
The literature on health communication messages has highlighted several techniques that are employed by communicators to ensure that the message is persuasive. There are relatively few historical studies in the area of health communication but, based on recent studies in the same field, it is clear from the evidence that the media can be an effective tool in health promotion, given the appropriate situations and conditions (Matamoros, 2011).
In instances where a substantial budget occurs, paid healthcare written messages, especially on posters and billboards, can be very expensive. Even media with limited reach, such as pamphlets and posters, can be expensive depending on the quality and quantity. Matamoros
(2011) further explains that, in order for a certain media to be measured as a strategy in health promotion, watchful attention of costs and benefits needs to be agreed to, given the idea that the behavioural goal is simple. Even though complex performance change such as smoking cessation or exercise adoption possibly will be introduced through media programmes, the nature of media is such that simple behaviour changes such as immunisation or cholesterol testing are more easily stimulated through the media. In general, the more complex the behaviour change, the more back-up is required to supplement a media health programme.
The clinician and the patient each bring their individual learned patterns of language and culture to the health care experience which must be transcended to achieve equal access and quality health care. Gibson and Zhong’s (2005) study examined medical providers’ own ability to communicate across cultures and patient’s perceptions of medical providers’ ability to communicate with a diverse patient population. Communication in healthcare is essential.
25
Effective communication is crucial between the patient and provider, because misunderstandings can lead to misdiagnosis and even death. Intercultural communication competence (ICCC) is important to understanding different cultures and to interact on an effective level (Gibson & Zhong, 2005). Language barriers and empathy can lead to miscommunication in the health care setting.
Several lines of evidence in the study by Gibson and Zhong (2005) made it clear that although their study focussed mainly on communication between healthcare providers and patients, the basic component remains that it addresses health communication. As such, this study, based on previous studies, believes that although health communication is insufficiently researched, it is essential, as humans depend on health habits for their survival, and the fact that they are social beings these habits should be communicated to them by using various media for them to reach a greater number of audiences as possible.
2.12 Summary
All in all, this chapter has demonstrated the relationship between health promotion messages and adverts. It discussed the tactics that are used in messages to make sure that they achieve their intended goal of persuading consumers to adopt health behaviours. It also gave an incite of how different stylistics principles such as foregrounding, style, affective stylistics, AIDA principle of stylistics as well as features like ambiguity and semantics, are used in healthcare messages to aid persuasion. It is now necessary to gather the data and analyse the posters and billboard that are used as health communication tools.
In the next chapter, the research methodology will be discussed.
26
CHAPTER 3
RESEARCH METHODS
3.0 Introduction
The chapter discusses the research design and methodology used in this research. The researcher used a qualitative approach since it seeks to do a content analysis of the health communication texts on a limited number of selected billboards and posters. Since it is a desktop study, the data was collected and analysed using the texts on the chosen healthcare communication forms.
3.1 Research design
Blaikie (2000, p.21) formulates a research design as a unified statement of justifications for the additional technical choices involved in planning a research project and a process, analogous to the activities of an object “analogous to the activities of an architect designing a building”.
Blaikie’s view is similar to that of Mushaandja (2007) who maintains that:
Research design refers to the plan and structure of the investigation used to obtain
evidence to answer the research questions. The design describes the procedures one
uses to carry out the study. Therefore, the ultimate aim of the research design is to
provide the most valid, accurate answers to research questions (p. 47).
The researcher used a qualitative approach since it sought to do a content analysis of the language style used in selected healthcare communication discourses as what makes the selected texts persuasive using different stylistics principles. Content analysis is articulated by
Patton (2002) as a way of analysing texts ranging from interview transcripts, diaries, document, etc. as opposed to observation-based field notes. Patton (2002) further states that:
27
More generally, however, content analysis is used to refer to any qualitative data reduction and sense making effort that takes a volume of qualitative material and attempts to identify core consistencies and meanings. The core meanings found through content analysis are often called patterns or themes (p. 453).
A detailed stylistic analysis was used to explore the style used in words which form up texts that are used in selected posters and billboards. A desktop study was utilised to analyse the discourse to establish whether, or not, the words themselves accompanied by the images as well as where they appear (the whole poster or billboard including the background) address the aspect of persuasion and whether they reflect the AIDA principle of advertisement (in this case, health promotion).
3.2 Population
The population of this study consisted of all the healthcare communication (promotion) discourses written in English.
3.3 Sample
The researcher used purposive sampling to select the posters and billboards that only contain health communication discourses. Kumar (2005, p.179) states that “the primary consideration in purposive sampling is the judgement of the researcher as to who/what can provide the best information to achieve the objectives of the study”. The research only considered the billboards and posters which were likely to have the required and relevant information to the study at hand.
Therefore, in this study the researcher only chose the posters and billboards which were believed to contain the required discourse or the information needed for the study. The researcher selected 14 forms of healthcare communication, seven billboards and seven posters.
28
It is only these types of printed media that were used in the study due to the limited scope of the thesis, and because they appear to be the commonly used form of communication in the healthcare sector, although they frequently do not have publication dates.
3.4 Research instruments
Billboards and posters were the only instruments used in this study.
3.5 Procedure
To gather the material that was used in the study, the researcher went around the vicinity of hospitals in Windhoek to take photographs of posters and billboards on healthcare communication displayed around hospitals. The materials gathered were analysed using the stylistics theory, i.e. it looked at the aspect of persuasion in the messages, the use of the
AIDA principle to raise awareness to the Namibian people and was also used to analyse the style and diction used in language. This procedure resulted in informed findings and conclusions.
3.6 Data analysis
The aim of data analysis, according to De Vos (2002), is to identify trends and patterns that reappear within focus groups, which is health communication posters and billboard in this study. De Vos (2002) maintains that when analyzing, the researcher should take into consideration the words, context, the initial and internal consistency frequency and extensiveness of comments. In the current study the researcher analysed the texts as per De
Vos’ view, the researcher also analyzed how what is not said in the text is viewed as part of what has been communicated using the relevant stylistics principles.
The main purpose of data analysis, according to Durrheim (1999) is to “transform information
(data) into an answer to the original research question” (p. 47). The current study was qualitative, and it made use of the interpretive approach. Blanche et al (2014) outline that
29 interpretive analysis can be seen as a back and forth movement between strange and familiar, as well as between a number of other dimensions which can either be description and interpretations, foreground and background, part and whole. The main idea that should be in one’s mind is to compile an account of the phenomenon being studied. This should be done close enough to the context so that other people familiar with the context would recognize it as true, but it should also emerge far from the basics so that it would help them to see the phenomenon in a new perspective.
Moreover, according to Durrheim (1999) interpretive approaches are best suited for use in qualitative studies. Unlike when we follow explicitly positivist approach, the interpretive approach tries to harness and extend the power of ordinary language and expression, developed thousands of years, to help us better understand the social world we live (p. 123).
Kumar (2005 p. 244) outlines that for qualitative studies, the most important consideration in developing frame of analysis is one’s preference of a particular style of writing. Kumar (2005) articulates that the way a specific method is employed for data collection communicates a great deal of how a study should be classified to a large extent.
The content of the extracted texts (phrases) for this study was analysed using content analysis which is part of the interpretive approach. Patton (2002) explains that the judgment lying behind purposive sampling is selecting information-rich cases for a particular study. The latter are those from which one can pick up aspects of crucial importance to the purpose of the inquiry, this is why it is called “purposeful” sampling (p. 230). He further explains that studying information-rich cases results in a great deal of understanding concepts in depth as opposed to making general assumptions. Hence, the study required a content analysis of 14 selected healthcare communication forms, using the stylistic theory. The findings were based on the
30 central research objectives and were further scrutinised to lead to the discussions and conclusions of the study.
The study used the stylistic theory, foregrounding, as principle of stylistics was used to analyse the distinctive features in the texts that make them achieve persuasion features to the readers.
The latter was used in conjunction with the AIDA principle of advertisement knotted on selected billboards and posters. Affective stylistics was used in the analysis of texts to establish as to how exactly catchy words with strong affective connotation were used in composing these healthcare texts. Other aspects such as semantics and style were also analysed to establish how persuasion is brought about in the selected texts. Since the study also involved textual interpretations, the researcher analysed the posters and billboards individually in relation to the objectives of the study.
3.7 Research ethics
The researcher sought permission to conduct the research from the University of Namibia
Ethical Clearance Committee. Billboards and posters were already displayed and available to the public. So, there was no need to ask permission to use them. The researcher respected the data collected by ensuring that no part of the billboards and posters photos that were taken was reproduced for personal gain or economic reasons. Data collected were used solely for academic purposes. The researcher sustained objectivity and integrity of the study by writing the findings in full. All the sources used in the study were acknowledged accordingly. The researcher did not fabricate or falsify the results of this study.
3.8 Summary
Chapter three explained the methodology used in this study. The study applied the qualitative research method. In addition, purposive sampling technique was used for this research to make certain that the studied features were represented in the texts that were analysed. The next
31 chapter discusses the presentation and analysis of data and the interpretation of collected data thereof.
32
CHAPTER 4
DATA ANALYSIS AND PRESENTATION
4.0 Introduction
This chapter presents and discusses the findings of the research. The presentation and analysis were done in a way that it would provide answers and information to the research objectives that guided this study. In this section, billboards are analysed first and posters thereafter. The objectives of the study, (as delineated in chapter one) are to: examine how the designed messages (words) and visuals used in the selected means of healthcare communication reflect the aspect of persuasion, examine how the AIDA (attention, interest, desire and action) principle of advertisement is employed in healthcare communication discourses in order to make sure that the massage changes specific behavior in people; and to discuss how foregrounding is used in the messages and how it contributes to the transformation of minds.
It is relevant to mention once more that the researcher selected 7 billboards and 7 posters for this study and they are all health-related. Yet these posters and billboards are not presented in a certain order or according to the texts. Each poster or billboard was analysed using the relevant stylistics element, AIDA of advertisement to assess how they persuade readers to take necessary actions. The next section is the commencement of data analysis
4.1 Data analysis
According to Grove et al. (2013, p.279) qualitative data analysis is “a process of examining and interpreting data in order to elicit meaning, gain understanding, and develop empirical knowledge.”
33
The figure below shows a picture of a couple expressing laughter. Within the figure there are words linked to the picture which are educating the public to adhere to some good healthcare practices.
Figure 1: billboard 1
4.1.1 Message alongside visuals/ pictures
This billboard has a white background which makes anything in it to stand out and be clearly seen by anyone coming across it. The billboard designer made a smart decision to incorporate a picture of a couple with smiles on their faces to attract the onlookers to the message on its side. After seeing the happy faces one will be curious to know what the excitement is all about
34 hence he/she will be enticed to read the message. The message is very short and precise to make sure it does not take much of the reader’s time.
For persuasion purposes, this billboard designer has also included the Ministry of Health’s website in order to inform the target audience that they can access more information related to taking HIV medication on that website. Apart from the Ministry of Health website, the
Namibian Coat of Arms was also used as a tool to inform the public that the message was official.
4.1.2 Persuasion via the AIDA principle
The smiles on the couple’s faces attract the reader’s attention. Normally when people are happy they either smile or laugh, and the world joins them in their laughter. When it flips the coin to the other side of things, that is when one is sad, they will endure their unhappiness alone.
Therefore, the billboard seeks to share the joy by finding out what the excitement on these people’s faces is all about. The use of the phrase “LIVE LONGER” in the title will make the reader eager to know what exactly one needs to do to live longer, and he/she will be forced to read further to gain clarity on this. If it was a choice, everyone would want to live longer therefore, these two words are persuading readers to take their HIV medications correctly and consistently if they want to live a healthy prolonged life. The title, with its colourful letters, is indeed made interesting by the use of these two words: “live longer”. The words that are in bold were purposefully used to influence readers to change their behaviour if they have not been taking their medication correctly and consistently. The target audience should do, as the text says, because it is the only way they can live longer and happily.
Here the “Ubuntu” theory is clearly demonstrated, (being who you are because of others).
These couple’s picture is persuading readers that HIV affects us all, hence, there is a need for people to work together in partnership to help those who are infected to take their medications
35 as outlined in the message. The readers here are also motivated to help one another in taking medications correctly with the aim of living longer as per heading of the billboard.
4.1.4 Persuasive words used
The writer made use of adjectives to persuade consumers to preserve their lives. The comparative adjective “longer” metaphorically designates how the lives of those on HIV treatment are actually not longer if they do not take their medication consistently. The word
“longer” persuades and adds more value to the message by assuring the target audience that if they go an extra mile of taking their medications correctly and consistently, they will get a bonus of living even “longer”.
The adjective “healthy” aids in the understanding and benefits of taking the medication consistently and correctly. The use of this word is merely for persuasion purposes because it is used ironically. If one has to consider the reality, if you carry on to take your medication as prescribed (correctly) and do not miss or take doses late (consistently), then the risk of HIV health problems in the future are very low. However, just as HIV negative people become ill, lifestyle changes. To reduce the risk of being vulnerable to diseases, which is equivalent to being healthy, one needs to do quite a number of things such as being physically active, eating a balanced diet, resting well and quit/not smoking. In other words, being healthy does not only come as a result of taking the medication, there is quite a lot of things involved, but the writer preferred to only persuade and convince people on the importance of taking medication effectively.
Furthermore, the writer expressed meaning, style and creativity by using the sound effect brought about by the two rhyming adverbs used in the message. The two adverbs “correctly and consistently” play a role of providing a sound that emphasises how the medicine should be taken. This is a regular rhyme that aids the memory of the message and also gives predictable
36 pleasure to the reader when reading. The writer is raising awareness while at the same time tries not to bore the readers as it would have been the case if the writer could have used different words. The word consistently does not only create a rhyming effect when used with the word correctly, but it also builds a sense of belonging and continuity.
4.1.5 Use of colour
The billboard designer made use of a white colour on the background. White is said to be a peaceful and calming colour. It is also believed to be the colour of cleanliness and perfection.
So, readers are enticed to believe that taking medication will bring them peace of mind or absolute bliss.
4.1.6 Graphological deviation
Firstly, the title of the text itself stands out for the reader because both words that make up the title are capitalized “LIVE LONGER.” The use of green bold letters in the title of this text makes it vivid that once you take your HIV treatment every day at the same time you will enjoy life more. The green colour was used because it is the colour that is associated with life or nature, hence, it will persuade the readers to consider living longer if they take their medication as stated. Secondly, the writer did put some words in bold to make it easier for the reader to at least remember only the important words, because they are the only ones that really matter in this message, “Take your HIV treatment CORRECTLY and CONSISTENTLY and live a
HEALTHY life”. The use of capital letters in this text marks the importance of some words in the text. Last but not least, this billboard has a white background in order to make anything in it to stand out and to be clearly seen by anyone coming across it.
37
4.1.7 The use of repetition
There is repetition in the sense that consistency is repeated by means of visuals that are in the form of constant frequency lines. The frequency lines are strengthening the word
“constantly” and persuade the reader to notice the importance of taking HIV medication consistently. This resembles the aspect of parallelism in the text. It is emphasising the outmost importance of taking your HIV medication consistently.
A sum of rhyming devices are also used to bring out phonological parallelism in the text. The word ‘correctly’ in the second line of the text rhymes with ‘consistently’. Rhyming creates a musical effect in the text, which also contributes to the understanding of the text.
The next figure is about male circumcision. It shows a picture with soccer players and a message on one side, which motivates males to get circumcised.
38
Figure 2: billboard
4.1.8 Persuasion strategy
The billboard has a blue background, and blue is said to be a colour for boys/ men. The use of soccer players reflects the aspect of persuasion in the manner that even young boys will want to be circumcised in order for them to be good soccer players. Soccer players are role models to most boys, hence, they would imitate what their role models are doing. The letters on these soccer players’ t-shirts are persuasive as they might mean getting circumcised is as easy as
ABC and they also represent the acronym of Abstain, Be faithful and Condomise. The acronym is persuading readers to get circumcised because it is as easy as ABC.
4.1.9 Powerful words and visuals
39
The very first word that will certainly persuade readers is the adverb ‘free’. People love free things. They have a tendency of always getting anything that is for free. So, the word free here is playing a big role of informing the readers that the service does not require a single cent. People are so fond of free things and they will make different choices, even when the respective worth of the item or service is not known to them. Equally important, when it comes to assembling words that really have persuasive powers in healthcare messages like the ones on the billboard shown on figure…, the writer had to think carefully on the choice of words. This billboard is adorned with the following words: FREE VOLUNTARY MEDICAL
MALE CIRCUMCISION AVAILABLE NOW! The adjective ‘free’ can swiftly grab someone’s attention and might cause them to ignore the word ‘voluntary’. “Free” can also be the first step towards “I should have known it was too good to be true”. By using this word, the writer changes a lot of uncircumcised men’s minds that they should not have a reason for being uncircumcised, because the service is given to them for free.
The second word that triggers the consumers to take action is the use of the adverb ‘now’. The word is used to inform consumers that the service is only available in the present moment if they don’t take this opportunity, they might miss out. The word forces them to take the necessary immediate actions as soon as they read the message. Healthcare professionals are indirectly talking to men and women about the benefits of the procedure, which includes protection from some sexually transmitted diseases, and the risks involved thereof.
4.2 Reflection of the AIDA principle
Men are mainly associated with soccer, and are attracted to everything that goes on about it.
So, this billboard designer made a decent choice of using soccer players so that men especially could be persuaded to get circumcised. The reader’s interest is gained in the sense that males are often interested in anything that has to do with football. Upon reading this text and viewing
40 the picture, one’s mind (uncircumcised men) will be transformed to take the necessary steps and get circumcised. The word ‘free’ that is used in the text will lead to a lot of men who are not yet circumcised to get circumcised since it is clarified that there are no fees required.
4.2.1 Violation of graphological deviation
The advert contains individual words that look like a paragraph, and four soccer players. The fact that this supposedly one sentence, which makes up the body of the text is split (word by word), each word making up a line of this text has already deviated from the norm. This is exactly what Gregoriou (2009) has outlined as a style that writers use to make sure that the specific written text draws attention to itself.
Moreover, the text is made to appear as a paragraph although it is only composed of seven words that in normal writing could form up a sentence, if the words were to follow each other horizontally. The purpose of the unfamiliar way of writing is to give this text a bold voice to convince and persuade readers that they really need to adhere to what is required. The style that the designer has employed in this figure has more persuasive powers compared to if it was written in a common way of writing. It gives readers guts to change their behaviours because the message is also written in a different way.
Secondly, the title of the billboard, which also happened to be the body of the text, is written in capital letters of different font sizes stands out for the reader, because had it been normal writing all the letters should have been of the same font size. This is obviously a violation of the graphological convention or practice. By so doing, the writer gives deliberate prominence to each of these words in a sense that each word in the text has its own authority. By capitalizing all the words in the text, the writer attempts to catch the attention of the reader, to look closely at each word in the text before figuring out the meaning. Some lines are indented, and this is purposefully done to contribute to the shape of text on the billboard. A given effect is achieved
41 on the reader because the indented words have a unique appearance and the reader’s decision making process depends greatly on the shape formed. The punctuation at the end of the sentence (!) implies that this is an exclamation and it requires immediate action.
4.2.2 Persuasion tactic
The use of the Ministry of Health and Social Services logo is to bring it to the reader’s attention that the information on the billboard is not propaganda, but rather meaningful information from the Ministry. So, seeing this logo, readers are persuaded to take the necessary steps to get circumcised after reading the text because the logo makes it clear that the message came from the Ministry of Health. These soccer players are not standing still, and they appear as if they are in action celebrating a victory. The writer persuades the readers that getting circumcised is an achievement that every man should attain and celebrate all its benefits as showed in the picture.
42
Figure 3: billboard 3
4.2.3 Chosen words
In figure 3, the billboard designer has used specific contextual cues, including powerful words that persuade people to think in certain ways about this product. The writer used catchy and interesting words to make the audience or the general public to perceive that Grand-Pa is the most effective relief to most aches. The writer used short phrases and was so selective when he/she chose the words used in this message to make sure that the message is as persuasive as possible.
43
The writer has used the phrase “READY TO WORK IN 10 SECONDS” to give readers an impression that these powders are very effective because they work in very few seconds. The writer also wrote ten in digits to make it really appear shorter, as opposed to if 10 was written in words. The adjective “ready” is also convincing the target audience that the medicine is already in a suitable state to fight all the ailments it is guaranteed to fight, so they should have no excuse of not buying Grand-Pa. The word ready gives an extra value and an elaborate meaning to the text. This picture also persuades readers through its cultural undertone by using the compound noun “Grand-Pa”.
In the billboard, Grand-Pa headache powders are said to be used for the relief of three ailments, headache, toothache, pain and fever. To compensate this, the writer used two delightful words
“TRIPLE ACTION” to persuade consumers to understand that should they have all of these three pin-pointed ailments, they should just take “one powder” then they will get all three for the price of one.
Moreover, in poems, writers use what is called poetic licence. In healthcare communication, writers sometimes practise something similar when they manipulate words, sentences or phrases (break grammar rules) in order to enhance persuasion powers of their texts. This means that healthcare messages do not also always adhere to the language rules. A classic example is used with the noun powder, which is typically an uncountable noun. On this billboard, an “s” is added to it to make it plural. In actual fact the writer tells the consumers that there are 38 individual bags of powder inside every Grand-Pa box of the same given size. This sounds very long to be remembered by the audience, therefore, the writer opted to rather find a brief amazing way of using thirty-eight in digits and making the noun powder countable “38 powders” to save up space, reader’s time and to make it more memorable and persuasive to the reader/target audience.
44
The writer has also provided information that the medicine is available in two forms (powder or tablet). The word “available” speaks louder than all other words. This means that the medicine is always in stock and it is easy to get. The writer used the words that make up this piece of information as a way of persuading readers that the product has been manufactured into various forms just for them. By doing this, the writer wants the target audience to feel special and valued as they will perceive that all their different needs are considered, and the choice is in their hands to choose whether they prefer the powder form or the tablet one.
4.2.5 Parallelism
Certain aspects or words are repeated so that they stick in the reader’s mind. Grand-pa is duplicated for the same reason.
The next figure is a promotion of a medical aid company. The billboard shows an image of a little boy with a smile on his face and the message bellow the picture that reads: “Own your health”.
45
Figure 4: billboard 4
4.2.6 The outline of the billboard
The billboard used a heading “own your health” to emphasise that people who take ownership or “possess their health” are always looking healthy, judging from the image used. The text designer formulated the content of the text in one sentence with the aim to make this verb phrase memorable and to save the reader’s time as readers do not really always have enough time to read congested texts.
4.2.7 Choice of words
In this particular text, the writer used simple and crystal-clear language. The writer used such language with the intention of getting the message quickly to the reader’s mind. These simple words are straight to the point, but they have convincing powers to change the reader’s mind/ way of thinking.
46
To start with, the verb “own” here refers to the possession of one’s health. Readers are intrigued to think again and ask themselves whether they take ownership of their health. Readers are left to ask themselves whether throughout their daily habits or in whatever they do ranging from their eating habits, physical activities, when they do their daily chores, etc. Do they really put their heath at the forefront? Readers are made aware that it is nobody else’s responsibility to control their health but themselves. Secondly, the pronoun “your” in this verb phrase is purposefully used to persuade readers to take ownership of their health, because by using this specific word, the writer talks to every reader in particular directly.
The writer’s intention is to let the information speak for itself so that people can make informed decisions about the best course of action for improving or conserving their health. These three words will be taken by every reader and link them to their own health status.
4.2.8 How images and visuals contribute to transformation of minds
The image in figure 5 shows a picture of a child. In actual fact, small children at the age of the one used in the picture know less, if anything at all, about their health. Their health is taken care of by their parents or by adults, but the billboard designer made use of the child’s image to persuade adults who can read to take full ownership of their health as this child. The writer wants readers to be realistic and ask themselves why they can’t own their health if this small boy owns his. The smile on the boy’s face is an indication that owning your health brings bliss to your life and it is worth doing.
4.2.9 Persuasiveness through the AIDA principle
The image of the child is drawing people’s attention and inspiring them to read the message and wonder why this child’s image was used in conjunction with this message. The green and blue colours on the billboard are also eye catching. Persuasion is mostly a portion of what we
47 see, feel and read in healthcare communication messages. The short and catchy message (three words verb phrase) used on this billboard is attracting the readers to pay attention to this billboard. The cute picture of a little boy with a smile on his face, combined with this short phrase makes this message interesting to the reader. The reader will have thoughts about how this little boy is taking ownership of his health. By using a picture of a happy boy, readers are persuaded to take action/ do the noblest thing by assuring that they take good care of their health.
Figure 5: billboard 5
48
4.3. Persuasive aspects in the text itself
In this specific billboard, persuasion is achieved by the text designer through various means.
Firstly, the text designer played around with the font size of the words. Although the whole text is written in big caps, the writer made a distinction as to where the reader should pay more attention when reading. The words that appear to have a bigger font size (SUPPORT,
HELPING AND CIRCUMCISED) are the major words in the text, hence, they have a bigger font size than the rest of the words. These three words are the text’s backbone, in other words, they are the ones that carry the meaning of the text. The rest of the words are just supporting words. The Ministry of Health’s logo is also a persuading aspect on its own. It is persuading readers to rest assured that this male circumcision message indeed came from the
Ministry. It is like the signature for the Ministry of Health officials.
The reason for the writer to use one clause, broken up into single words that looks like a poem stanza may be to show that the writer intends the clause to be read as a whole and places emphasis on the union of the discourse. The intention is also for the reader to pay attention to each word and its role in the text. The billboard designer made use of different colours to avoid boring the readers and to make reading interesting.
4. 3.1 Reflection of the AIDA principle
The way this text appears is just fascinating. The reader’s attention is also captured by the use of the use of a beautiful image that represents a family. The entire text is eye catching in the sense that the writer plays around with the font size and type as he/she tries to persuade the public to get involved in male circumcision. The reader will have endless ‘whys?’ as he/she reads this text, e.g. why are some letters bigger than the others? Why is it not written as one single sentence? Why do some lines have one word while others have two or three? Apart
49 from the picture being the attracting feature on this billboard, the way the words are put is arousing the reader’s desire to take necessary actions or measures.
4.3.2 Images and visuals used
The different ages of males used in the picture is a way the writer used to inform the intended audience that no one is either too young or too old to get circumcised. It is therefore a persuasive aspect to have people of all ages to get circumcised. Since the billboard contains a text that reads: “Support the nation by helping your loved ones getting circumcised”, the writer made a smart decision of using an image of a lady and two men. By interpreting the picture alongside the text that accompanies it, the reader may be convinced that this is a family picture where the lady is helping the men next to her to get circumcised.
From a psychological view, persuasion is most effective when the person persuading is viewed as reliable and trustworthy, and the message being conveyed is perceived truthful, precise and aligned with an individual’s, or audience’s, values and interests. The Ministry of Health logo persuades readers that the information came from a trusted source.
3.3.2.1 The presence of affective stylistics
The writer charms the readers by using the phrase ‘loved ones’. It is a jovial feeling to be surrounded by healthy people (loved ones) so, readers are persuaded to make sure that the people who are dear to their hearts are circumcised and that they (readers, males or females) play a role in this initiation. These two stunning words will evoke in the reader the perception that if he/she really loves and cares for his/her loved ones (males) then he/she must support the nation by helping them get circumcised. Furthermore, the writer declares the intense feeling of the love that these people harbor by making them stand so close to one another.
50
4.3.3 Foregrounding
In this text, foregrounding is produced through two specific devices, deviation and parallelism.
Gregoriou (2009) defines deviation as the difference between what we take to be normal or acceptable and that which is not. This leads to breaking rules or expectations in some way. In this text, the most prominent level of deviation is graphological deviation alongside the parallelism device.
4.3.3.1 The presence of graphological deviation
The billboard with the text ‘SUPPORT THE NATION BY HELPING YOUR LOVED ONES
GETTING CIRCUMSISED’ employs graphological deviation, which is concerned with the appearance, meaning and encoding of meaning in visual symbols. Firstly, the appearance of the text itself stands out for the reader because the first word of the text is capitalised like every word within the text, but it appears to have a bigger font size than the words that followed thereafter, in the next line. In texts, normally, all the words comprised of the text are written using the same font size.
Typically, the capitalisation or different font size or type, should have been restricted to the first letter of the opening word, or to the tittle, should there be any, but in this case since there is no title, the word ‘SUPPORT’ can play a dual role by being both a title and a word adding value and meaning to the text also. This is obviously a violation of the graphological convention or practice. By so doing, the writer gives thoughtful prominence to each of these words in a sense that each word in the text has its own persuasive power. By capitalizing each word in the text, the writer attempts to catch the attention of the reader, to look closely at each word in the text one by one, before moving on to the next. Therefore, the phrasing alongside font type are persuasive effects that the writer achieved in this text.
51
Figure 6: billboard 6
4.3.4 Captivating words used
The writer showed creativity in language use to get the message across that, everyone is entitled to quality health services. Readers are told what benefits them with a powerful phrase that reads: “Right to health”. The word right will sensitize readers that their needs and rights are taken into consideration and they are rated as a first priority. By reading this message, readers are persuaded and made to understand that they have a right to health.
52
By making a general statement as this one, “Right to health”, the writer hopes to influence everyone by informing them of their rights. Therefore, readers are persuaded that they should not be afraid to seek medical treatment and/or assistance because it is their right. Readers are made to understand that their right to health guarantees them protection.
4.3.5 The AIDA principle and graphological deviation
The bigger font size of the letters that make up the headline of the billboard attract readers.
Different visuals seen in the text, but especially the pictures of a red “take control” sign arouse the reader’s interest to pay attention to this message, while at the same time informing them that this is a health message. The image of the Namibian Kwaito Artist, The Dogg, was used to attract readers to this message. The use of small images (condoms), reduced font size of the words attached to the “take control” sign, made it vivid that HIV is one of the health issues presented in the pictures, but it is kind of hidden at the end of the text not to bore readers as opposed if it was presented earlier in the text. Most of the posters/billboards are about HIV, so if the reader’s eyes land on the word “HIV”, he/she might lose interest in reading further.
HIV is a familiar health concern. Starting off this message with what seems to be a new subject is fascinating and readers will want to pay full attention to it. The writer made a smart choice of a brilliant way to get the full attention of the readers by using a short, catchy and pleasing statement which seems as if it has nothing to do with HIV.
The following figure shows a health promotion billboard for the Dettol products. The designer used picture that accompany the words to influence the readers to start/continue using Dettol products.
53
Figure 7: Billboard 7
4.4 Where the billboard appears
The idea of using a technological platform is just fascinating and persuasive on its own. The billboard designer made a smart choice of using a unique platform to display this hygiene related healthcare text. Despite spending a lot of money to get this message on this technological device, this is the most convenient way of getting the message across despite the
54 time of the day. The fact that the designer made use of the lime colour which is normally associated with cleanliness, readers are being persuaded that Dettol is the best soap. The platform where this billboard is displayed is very fascinating, and it will be explained in details in the next paragraph.
4.4.1 Significance of the AIDA principle in the text
The use of this electronic device in itself is already attractive, so potential consumers will be persuaded by almost everything that appears on it, be it boring to read or not, because the device makes it interesting to watch and read. For example, the manner in which this text pops up is remarkable; it first shows the pictures, and thereafter, the words will appear. The consumers are entertained in this way and their desire to use Dettol products to prevent themselves from unwanted germs is increased. This device lights at night and the text is eye catching especially at night and everyone is attracted to it and would want to read it and just keep staring on it.
Consumers will take immediate actions because they are told to leave whatever products they have been using before reading this text, because it assures them that once they use these products, they will be 100% sure that they are protected from germs.
4.4.2 Persuading words and graphology employed in the text
Almost every word used in this text has a persuading effect on the readers. These words will make one to think that this hygiene product is the best of the best. How the product is described by the superlative ‘best’ will change the reader’s behaviour, which is to abandon products such as Protex, Sunlight and many others and start using Dettol just because of the charming word
“best”. The word protect/ protection is common in the healthcare sector. Like in any other healthcare communication/promotion text, the word protect is used to change the reader’s behaviour and believe that there is no other soap that protects them against germs than Dettol.
The writer further claims that with Dettol you will be 100% sure.
55
Furthermore, words that are in the white box are isolated for the reader to pay attention to them separately. The writer tried to answer all the questions that the reader will have after reading the colourful words in blue and green that read: ‘EVERYDAY BEST GERM PROTECTION’.
The writer knows very well that there are different types of germs that surround us hence, ensuring the readers to protect themselves from them by using Dettol.
The language used in this text concurs with the words of Kangira (2009) because the comparative adjective “best” in the text has an extra role of changing people’s mind. This word will result in readers switching from whatever they currently use to Dettol as they are assured that by using Dettol you will be 100% sure that the germs are gone. The phrase “be 100% sure” was used deliberately to win the readers’ desire for the product. The text bellow gives an insight of how the re-occurrence of certain elements, and how it contributes to persuasion.
4.4.2.1 Repetition on the billboard
The re-occurrence of the word Dettol is the resemblance of the aspect of parallelism. It is seen all over the text as it is repeated thrice. The intention of repeating the word Dettol is to paint an image in the readers’ minds, to make it more memorable and hard to forget.
56
Figure 8: Poster 1
4.5 Persuasive words used
All the words that writers use are vital in persuading readers and getting the message across, but, some words are more important than others. These are the type of words which contribute more on the decision making process of the target audience. In this particular poster, the words in red are as important as the ones in white. Among all these words, the word “risk” speaks louder than any other word in this message. No one wants to be at risk of any kind because the word has a negative connotation. The writer wants readers to do something in order to know whether they are at risk or not? By asking this question, the writer attempts to reach out to persons who do not routinely seek medical care for their health problems.
Moreover, the use of the personal pronoun “you” alerts the reader that the writer is indeed asking him/her as an individual, and to answer this question, the reader has to get tested for diabetes. The idea of asking a rhetoric question persuades readers to take action and adopt good health practices or change their behaviour.
4.5.1 The AIDA principle of advertisement
The white and red colours of the letters are the attractive features on the poster. White and red goes well when combined hence, they look appealing to the reader’s eye. The manner in which the first line of the text is written (numbers sandwiching a word) is attracting readers because it looks unique, as opposed to if numbers were written in words. The reader’s interest here is aroused by the frame that surrounds the poster which might click to the reader’s understanding that it is worth reading. The content of the poster is framed to improve the poster’s worth and quality as well as to give it a great look. Framing makes the message look formal and genuine.
57
4.5.2 Affective stylistics in the text
The text is partially written in red, which is cautioning the readers to pause and think deep about whether they are aware of their diabetes status or not. When such a figure is being talked about, it is really an alarming figure and one will be stimulated and persuaded by this figure that is written in red to get tested for diabetes. The purpose of the writer to end it off with a question mark is to sort of frighten readers who do not yet know their diabetes status to take immediate actions by visiting healthcare facilities and get tested for diabetes. The word ‘risk’ in the question has a strong negative affective connotation because, risk is believed to be something bad or dangerous. No one will ever want to be at risk of any kind, people always prefer to be on the safe side. Therefore, readers are persuaded here that it is vital to know their diabetes status and know whether they are at risk of having it or not, since 1 person in 2 people with diabetes don’t know they have it.
4.5.3 Graphological deviation in the message
The text designer ends the text with a punctuation, which is a question mark (?) in particular to advocate that the question is meant to elicit evidence from the recipient. The rhetorical question will intrigue the reader to look forward to the content of the text in order to get the answer to the rhetorical question. Therefore, to answer this rhetoric question one has to visit the health facility or search for more information to know who is at risk of getting diabetes and when.
Part of the text that is written in white is surrounded by a black colour to symbolise that if you are at risk you are in darkness. It is well known that darkness always comes with all the bad things. The same text in white is enclosed in a circle to demarcate the reader’s attention. The other graphological feature portrayed in the text is capitalization. All the words are capitalized, giving each word its own mandate and drawing the reader’s attention to every word.
58
Figure 9: Poster 2
4.5.4 The entire poster
The poster as a whole displays the lower part of the body of the male person, from the chest to the abdomen. The background and the sides of the poster is decorated with a pink colour to make what is not said in the poster to be perceived as part of what is said (breast cancer is mostly known to affect ladies only but the poster makes it clear that it affects both males and females). The word “face” in the poster was purposefully chosen and skilfully used alongside the image drawn in the tummy of the person in the picture to persuade the readers that breast cancer affects the areas or body parts indicated (breasts and around the whole belly). The writer has used simple words but not medical terms. The words used are very easy to understand and readers will easily interpret the message as the writer intended.
4.5.4 The AIDA principle
The number one feature that catches any reader’s attention is the image of the face drawn on the person’s body. By looking at this face-like image, one will be really persuaded that breast cancer affect a person’s body and form up a face. Hence by using this image to accompany the text, the writer has it in mind that he/she will change specific behaviours in people such as wearing black tops/vests or dressing in clothes that cover up the areas that may form up the breast cancer face.
59
4.5.5 Graphology verses persuasion
The first visible feature is decapitalisation. The writer has used small letters to give a unique appearance to the text. In most cases, posters are written using capital letters but in this spectacular message, the writer wants the readers to pay special attention to the text hence, the content of the text is written in lowercase. The image of a face drawn on the body of the person in the picture is persuading readers to be extra vigilant and avoid getting this type of cancer by all means. The idea of using a gentleman’s picture without a t-shirt is to persuade readers and change the perception that breast cancer does not only affect women but it affects men too. The other visible graphological feature in the poster is the use of ellipses in the phrase “be aware…”Ellipses show that this is an incomplete sentence and readers should make sense out of it by completing it with the information known to them concerning breast cancer.
60
Figure 10: poster 3
4.6 Poster outline
The poster starts off with a headline which appears bigger (in terms of the font size) than any other writing in the text. The text is further divided in three sub-headings which are separating different ideas in the four paragraphs that make up the text. There are pictures seen here and there in the poster which enhance clear interpretation and understanding of the message.
61
4.6.1 Words, visuals and images used
The writer used simple discourse that can be easily understood by everyone, no medical terms used to contradict the reader’s understanding of the message. The writer crafted the first sub- heading in a question form to gain information from the readers, whether they really know what a healthy lifestyle is by using the words that the reader will want to hear. Sub-heading one is followed by a simple but clear explanation of what a healthy lifestyle is, whereby the words that are used are appropriately chosen to have persuasive ends on the readers.
In the first paragraph, the writer made a creative use of vocabulary. The three words that are written in caps in the first line have great persuasive power. The reader will first see the words that are in upper caps ‘HELPS YOU ENJOY’ and ‘LOWERS YOUR RISK’. The words that are in caps are outlining how a healthy lifestyle is beneficial to readers. These words will mean to the reader that the writer is really talking to him/her. The word “help” is very useful in the paragraph because the writer has used it to persuade the audience that a healthy lifestyle assists you to ‘enjoy’ life more. The writer used this degree of comparison to get the message across.
Currently the audience is already enjoying life, but if they take all the necessary precautions, they will enjoy ‘more of life’. The word “more” was used intentionally to compare the current situation and the life after knowing and living a healthy lifestyle.
The title of this poster consists of two words that are written using capital letters. The words are given a dark green colour to alert readers that this is a health message right here, and it is worth paying attention to it. Green was chosen as it is a colour which resembles nature, health and growth. The writer and the designer of this poster are of the opinion that using this colour for the title and some more components within the text will give readers a lively emotional state of mind when reading this message.
62
The poster depicts a combination of various pictures that represent good health practices and it is also congested with words outlining how to adopt a healthy lifestyle. The poster will require much of the reader’s time, hence, many beautiful pictures were used to break boredom that comes with reading plain words explanations. Pictures do as well facilitate the understanding or the correct interpretation of health texts.
The one spectacular picture used is that of the lady exercising (jogging). This is persuading readers that, exercising is always associated with a healthy lifestyle. It will persuade the audience especially those who only eat healthily but they hardly exercise to change their habits.
The writer is informing the readers that exercising should also have a portion in their schedules should they opt to live a healthy lifestyle. People so often say one needs to take care of their bodies because it is the only one you have. If you ruin it now, by not making sure it is healthy, you don’t have spare parts to repair the ones that are worn out. Making sure you are living a healthy lifestyle by either exercising as shown in the poster, eating healthy and adopting all the healthy habits should be the number one priority of everyone. No one wants to be unhealthy, henceforth, readers are persuaded to change their lifestyles and make informed decisions concerning their wellbeing.
In addition, the two pictures that show a variety of fresh fruits and vegetables in different colours look pleasing to the reader’s eye. They look colourful and readers will want to eat fresh colourful food. The way they are arranged and displayed will make readers assume that they are the healthiest. By using these pictures, the writer is also raising awareness to the public about different types of healthy fruits and vegetables. Most people are only familiar with fruit and vegetables such as apples, bananas, pears and grapes, green papers, cabbage, etc., but in the pictures, readers are also introduced to others such as red and yellow pepper, grape fruits and broccoli.
63
The pictures that are used in this poster show people who look healthy. They are persuasive in the sense that they are telling the readers that if they adopt healthy lifestyles, they will look healthy like the people used in the poster. Images like the first one which shows a child jumping with a smile on her face is convincing readers that even small children are entitled to live a healthy lifestyle and if that is accomplished, it leaves a smile on their faces as shown in the picture.
4.6.2 AIDA principle and health communication
The different bright colours used in this poster are attractive. And they are inviting any passer- by to stop and read. Normally, when reading a piece of writing, a lot of people find it interesting and worth reading when it is accompanied by images or visuals, and this is the same with healthcare messages. Images make the message interesting to the readers.
4.6.3 Foregrounding in the message
The massage in this poster is extra ordinary due to the fact that it starts with the Namibian Coat of Arms followed by the title. Routinely, most of the health communication discourses start with the heading, and the Coat of Arms or logos mostly appears at the bottom. The latter is one of the unique and persuasive features in this poster. Readers will be keen to know which health measures or guidelines are the best to adopt.
4.6.3.1 Graphological deviation
The punctuation marks all over the text serve the purpose of offering a slower reading tempo which enhances in the understanding of the text. The text is highly punctuated, therefore, when reading, readers are convinced of where to take a short pause by a comma (,), where to pause
64 a little longer, indicated by semi colons (;) and where to completely stop marked by a full stop
(.).
Furthermore, the writer used a comma (,) in the first paragraph to mark a slight pause in a unit of thought and to separate ideas. In the last paragraph, commas are used to separate items in a list. Full stops in all the paragraphs, exclamation marks and colons can also be seen in the text.
The punctuation marks help the reader to separate thoughts and to better understand the message.
The writer used the different colours for the heading and sub-headings. The writer gave the sub-headings a colour (yellow) different from the colour (white) of the words in each paragraph for the readers to get a glimpse of what to expect next in each paragraph. “Yellow” is said to be a colour that resembles happiness, so the writer encouraged the readers to adopt healthy lifestyles because there is happiness attached to it. The white colour of the words in each paragraph represents cleanliness that is a bonus for living a healthy lifestyle.
The other graphological deviation feature portrayed in the text is capitalization. Capital letters are used normally to emphasise the most important aspects in the text. The first letter of most of the sub-heading words are capitalized to pull the attention of the reader to every first word of the sub-title.
4.6.3.2 Rational of dialectical deviation
This type of deviation is used as per Gregoreu’s (2009) point of view, as a way of borrowing some features of socially or regionally defined dialects. In this particular poster, the writer has deviated from the norm by incorporating some Oshiwambo words in the English words. The writer knows exactly that the Oshiwambo speaking people make up quite a bigger percentage of the people residing in Windhoek. Using the words such as “oombe, oonyandi and oonkuyu”
65 the writer believes that the Oshiwambo speaking people will be persuaded more when these names are written in their vernacular than if they were only written in English. The same people are also persuaded and encouraged to lift up the standard of their traditional fruits by valuing them just as they value other fruits like apples, bananas and so forth.
4.6.3.3 Parallelism in the text
The concluding sentence for eating a balanced diet is just a repetition of what is shown by the picture that has different fruits and vegetables. The writer is persuading, emphasising and reminding readers not to forget eating different types of food because all the nutrients are not found in just one particular food. Therefore, eating different types of food (balanced diet) is part and parcel of a healthy lifestyle.
66
Figure 11: poster 4
4.6.4 Outline of the entire poster
It is well known that HIV is a deadly virus that is killing not only “Windhoekers” (Namibians in Windhoek), but a lot of people in different countries around the globe. Health workers are hard at work to find mechanisms on how to prevent this disease from spreading from one person to another. It is no new thing in this poster as it outlines one way in which HIV can spread from the mother to her infant through breast feeding.
67
4.6.5 Captivating words used
Raising awareness and persuading readers on different ways to prevent their infants from getting HIV, it is the full responsibility of the writer to make sure he/she uses captivating words to get the reader’s attention as well as to convince them on different HIV related matters. The writer made a creative use of vocabulary to persuade readers that HIV positive mothers should take their HIV medications and breast feed their babies because breast milk is the best food that mothers can give to their babies. Readers, especially the HIV positive mothers, are persuaded to breast feed exclusively.
The writer used the personal pronoun “I” for the readers to view themselves as part of the message when they are reading. The pronoun “I” is also used by the writer to convince HIV mothers who are on HIV medication to do the noblest thing and follow in the footsteps of the writer. The possessive pronoun “my” also plays a role in convincing the intended audience that they are doing it for themselves and their loved ones.
The paragraph at the bottom of the poster has used many words to explain what the words on top of the poster mean. If readers read until the end, they will get a much clearer view of what is expected of them. The writer used the word “important” to inform the readers that it is prominent to breastfeed even if you are HIV positive as long as you are taking your medications.
The closing statement, (last sentence) at the bottom of the text is designed with some more words with strong positive affective connotation. “Give hope and future for the next generation.” Readers will take it that should they do what is required of them, at least they are doing a great favour to their children (giving hope). This is a positive and smart way that the writer used to convince and fascinate readers to do the most decent thing by taking their medications while breastfeeding.
68
This message was tailored with stout words which have great persuasive powers to change the intended audience’s behaviour. They appeal to people who are HIV and have given birth, by addressing their collective needs and expectations related to breastfeeding and anti-retro viral drugs, as well as their need for information about the connection between this behaviour and health outcomes.
4.6.6 AIDA and graphology
“HIV POSITIVE MEDICATION. BREASTFEEDING BEST FOR MY BABY”
The writer used three different fascinating bright colours to gain the attention of any person passing by to read the colourful words. The writer used capital letters to give every word its own right. The expression that is written with a bigger font size is put in a white font colour so that the words making up this expression stand out from the rest of the words. These words are the pillar of this message and this is where the reader’s eye should focus. By only concentrating on these eight words (white letters) the text reflects the aspect of persuasion especially by using the adjective “BEST”, and by the fact that the white letters are clearly visible from all the three colours.
The figure that follows is a poster with a message that is designed like a stop sign. It looks like a traffic sign that cautions road users to stop.
69
Figure 12: poster 5
4.6.7 Persuasive words
This poster is pasted on a glass swing back/free door. The surface where it is pasted makes it visible for everyone passing by because it is on a clear surface. All the people who will go through this door will see it because the door is always closed. The poster is designed as a traffic road sign which is used by road users. The writer charms the readers by using simple but meaningful words.
The word stop is the most persuasive word in this poster. The writer used the verb ‘stop’ to caution people to break at the door before opening /going inside and figure out why they are warned to stop by this poster. The manner in which this traffic-like stop sign appears, it is as if it is warning people about some sort of serious danger that is ahead, therefore, without any second thought everyone who intends to use this door has to stop and read. The stop sign in the picture also means that people should avoid getting the flue by all means by getting a flu
70 vaccine every year. By using the word ‘stop’, the writer intents to persuade readers that if they get a flu vaccine, one has a 0% chance of getting flue, so getting a flu vaccine is the best way to completely stay away from flue.
“THE BEST WAY TO PREVENT FLU IS TO GET A FLU VACCINE EACH YEAR”.
People who value health are always on the lookout on health information especially on how to prevent themselves and their families against viruses and diseases. People will easily get persuaded by the comparative adjective ‘best’ because according to this text, getting the flu vaccine is the best, therefore, they are assured that among other ways of preventing flu, the one being spoken of in this poster is the best so people will get vaccinated against flu because they are told that this is the greatest way. The writer has used the adjective “best” as a technique to diagnose the interests and needs of targeted individuals so that the message will have enough impact to change perceptions and attitudes and improve skills on whatever way of preventing flu the readers know, thereby leading to the desired change in behaviour.
Apart from raising awareness that one can simply get a flu vaccine, the writer did not include all the information as to where one can get this vaccine and whether there is a fee required to get it. The writer made it sound like flu vaccines are for free although in reality they cannot be given for free. To avoid being troubled by people, the writer outsmarts the readers by informing them where to get more information regarding this issue. There is no specific healthcare provider given/ made responsible for this, but the writer simply said ‘FOR MORE
INFORMATION, PLEASE SPEAK TO YOUR HEALTHCARE PROVIDER.’ This statement is informing and making it clear to the readers that there is no a specific healthcare facility/provider that gives the best flu vaccines, but they can get it anywhere. All they will have to do is just to speak to their healthcare providers and it shall be given to them.
71
4.6.8 The AIDA principle
The bright red colour used is so flashy and bright, making sure it is seen by everyone. The stop sign used look similar to those ones that are used as road traffic signs. This is very impressive, as readers will be keen to know why they are asked to stop. It will obviously persuade any passer-by or reader to ‘stop’, read and understand why the writer cautions them. The poster was designed in such a way that the designer really wanted anyone coming across this poster to read it. The idea of making the letters in the word “stop” to appear bigger is just interesting.
4.6.9 Graphology
The punctuation that is used (a full stop) acts as a cut of line. It indicates to the readers that an injection is all that one needs to prevent flu. A full stop normally indicates the end of a sentence like in this case, but in this message, it is also used with the intention of showing that this is all one has to do. The red colour is convincing the audience that there is danger ahead, thus they are required to stop and read before endangering their lives. The eight sided shape in which the word stop is enclosed, is used to give the readers an impression that this is a stop sign that requires everybody to stop and read, just like the one they see in roads as a traffic sign. All these graphological deviation features used in this poster are persuading readers to take action that is getting the flu vaccine every year.
The next figure displays a foot in a poster. Inside a foot there are words that were carefully chosen to influence readers to buy the gout pain relief products.
72
Figure 13: poster 6
4.7 Layout
This poster portrays various gout medicines, and it is designed in a very fascinating way in a sense that it is shaped like a person’s right foot, while at the same time it also looks like a pickle plant with its thorny fruits. Just the way it is designed, it already has an influence on the reader’s decision making. The reader is left with no choice, but to assume that this is the best pain releif
73 ointment for gout, judging from the the information provided. The reader is, therefore, entirely persuaded to assume that it is worhwhile letting go of whatever medicine they use to relief pain, and use the one being described in the poster. The writer tried by all means to make a long story short. It is well known that gout is a serious disease especially in Namibia, not only in Windhoek, eventhough the poster being dealt with was captured in windhoek.
4.7.1 Persuassive words used
Using only carefully selected catchy and convincing words, the writer manages to get the message across so that people with this health concern will suffer less, or no more. The message across to summarise only the little that the poster of the size used can accommodate.
The writer showed some sense of audience in this particular poster because he/she knows if he was to only give the name of the pain relief ointment for gout without saying a word using the word GOUT (in caps), readers will not stop or render their attention to this poster because the medicine has a medical name and most of the readers are not familiar with such a name. So to overcome readers ignoring the message, the writer or the person who designed the poster made a smart decision of writing the word GOUT in the middle of the poster or rather at the center of this poster. Immediately after the word gout, the two words that followed are the ones that are even more persuasive (EMERGENCY PACK).
4.7.2 AIDA
What captures the reader’s attention in this poster is the shape in which this message is crafted.
The colorful picture of the foot with its toes is attracting readers to pay some close attention to the poster. The readers’ interest here is aroused as the box that contains the medicine appears bigger than it is in reality and, because of this, consumers will want to use it with the perception that it will last because, since the box is big, there should be many tablets.
74
4.7.3 Foregrounding
Gout is said to typically affect the joints in the base of the big toe, hence the reason for the designer of the poster to give the toe a red colour to indicate where the danger is. The toes on the foot, if viewed as pickle plant’s friuts, have tiny thorns which stick people when eating these fruits. The thorns on the foot give an idea how painful gout can be, hence the readers are convinced to use this gout pain relief medicine.
4.7.3 Persuasion
There is a variety of gout relief medications, but the poster is persuading readers that this specific one is the best since it is said to be suitable for the emergency attacks. The ‘emergency attack’ idea is convincing readers that other pain ‘relievers’ only releif the common pain, but this specific medicine is suitable for emergencies as well. That is why the writer wants the readers to have these particular ones and not anything else. Readers, or consumers, are also given two options to choose from, THEY EITHER CHOOSE COLCHICINE RHEUGESIC.
They are also given aditional information that RHEUGESIC comes into different sizes.
Readers are well informed about these medications and they were given options too.
The figure bellow is a poster raising awareness on TB. It contains three pictures of one person demonstrating how to prevent spreading TB when coughing or sneezing.
75
Figure 14: poster 7
4.8 Persuasive words and images
In this text, the writer positioned the words or the information that is most critical for convincing the audience to adopt the recommended behaviour early in the message. By doing this, the writer is of the opinion that the audience who lose interest, or become otherwise distracted, will still have the opportunity to process some key words of the message even if they decide not to read further.
76
By using this statement right at the biggining of the text “ Stop the spread of germs that make you and others sick!”, the writer made a smart decision of letting readers know from the beginning that what is going to be said will benefit them. The writer creates a bond with his audienence and at the same time influences them to implement the best ways to avoid the spread of germs. The pronoun “you” is mostly used in healthcare messages because it gives the reader the satisfaction that the message is really about them, and they will concider themselves as part of the text as they read. Using the word “you” reader will, with ease, be persuaded to abide by what the reader communicates to them.
Literally, it is not possible to “cover your cough”. The phrase that makes up the heading was supposed to read: “Cover your mouth when coughing ” but, instead, it is written vice versa.
The word “cover” is already telling the readers that they must have some sense of protection and hygiene when coughing. To add on that, the writer made sure that he/she was not just speaking but rather saying something persuasive by using cautioning words such as “stop”.
The Namibian Coat of Arms aided in persuading readers that the message came from a trusted source, and it is wothwhile following all the advice within the poster. The writer used the language consisting of simple words for everyone to understand the discourse.
4.8.1 The AIDA principle of advertisement
The pictures of a beautiful lady dressed in white, have been used to attract the reader. The pictures are also used as a means of demonstration. The writer engaged the reader’s interest by using the personal pronoun “you”. The use of these pictures will persuade readers to adopt these ways when coughing or sneezing because the way the lady is doing it just looks irreplaceable (cough or sneeze into your upper sleeve, not your hands). Although most people resist change, some people will always want to try out new things like coughing into their upper sleeve, than the old way of coughing into your hand. This is the action that readers will take
77 after reading and seing the image. By designing the message with the words used, the writer believes in the power of the words used to persuade citizens to agree on the facts in the posters concerning TB.
4.8.2 Foregrounding, Grapological deviation
Stop the spread of germs that make you and others sick!
By shading the background of these words black, the writer makes this particular sentences stand out from the entire text. Although the black colour is generally associated with all the negative things like death, darkness and so on, in this particular text, it is a different thing. By using this colour, the writer wants the reader to pay separate attention to this exclamation in isolation and understand that black can be a positive colour too. The use of an exclamation mark is to add additional emphasis and to strengthen the persuasive power of these words.
4.8.2.1 Repetition
Each picture used in the text is a repetition of the paragraph next to it. The images are a means of demonstrating the ways of how people must stop spreading the germs when coughing. By accompanying these words with pictures, the writer hopes to persuade the readers to practice coughing in the most appropriate way. The other purpose of using pictures is to make it easier even for the illiterate people to get the intended meaning. This will result in a lot of people changing behaviours as they would imitate and adopt the new ways of coughing.
78
CHAPTER 5
DISCUSSION AND CONCLUSION
5.1 Introduction
The purpose of the study was to do a stylistic analysis of the discourses used in healthcare communication on posters and billboards in Windhoek. This is the concluding chapter of this thesis. It summarises the findings of the study, and provides possible recommendations.
5.2 Persuasive words and visuals used in the discourses
Prosperous health promotion efforts mostly rely on various strategies to persuade audiences about complex health concerns, different healthcare products promotion, causes of different diseases and prevention. Healthcare discourses that are effective, in terms of persuasion, are crafted with the designer’s enormous time to select the appropriate words. Not just any word can be used in healthcare communication. In some cases, healthcare billboards designers substitute adjectives that could have been appropriate in an ordinary discourse, with a synonym that has great persuasive powers in order to change people’s minds or behaviour.
In healthcare discourses, persuasion is achieved at the beginning by the opening words of any message on the poster or billboard heading and/or the foremost words of the text. Mostly, writers use present simple tense or present perfect continuous tense to persuade the readers to adhere to the healthcare message being communicated to them constantly.
The study revealed that healthcare communication best supports health promotion by using multiple persuasive features such as carefully selected adjectives, short and catchy phrases, enticing verbs and adverbs, attractive pictures and visuals. All these features are used to influence specific audience with healthcare information that is appropriate and relevant to them. The study has revealed that words used in healthcare communication messages are
79 wisely chosen to add more value to the message and they assure the target audience that there are additional health benefits in the message. In addition, billboard/poster writers make sure that they use simple discourse (not medical terms) to make certain that the readers interpret the message as it was intended by the writer, and subsequently take the appropriate actions.
In this study, images and visuals were used alongside words to aid in the better understanding of the messages on posters and billboards used in the study. Images and visuals were as well used to make the text attractive and appealing to the readers. The use of pictures in the text is the effort designers make not to bore the readers. Conclusions have been drawn from the study that most of the healthcare posters and billboards used different logos including that of the
Ministry of Health. The Ministry of Health’s logo was purposefully used to persuade readers that the message came from a reliable/trusted source, hence, they will have a perception that adhering to the message is worthwhile.
The designed messages (words) and visuals used in the selected healthcare communication messages, reflect the aspect of persuasion in many ways. The ways in which words persuade the readers range from the use of powerful words (mostly adjectives) which can swiftly grab someone’s attention, and the use of words that require immediate action e.g. “now”, to using a limited number of words in a message. Writers also used rhyming words (figure 1) to make it easier for the readers to remember the message.
5.3 The use of the AIDA principle in healthcare communication discourses
AIDA (attention, interest, desire and action) is a principle used in advertisements, but the study exposed that it is also used to a greater extent in healthcare communication messages. It can be concluded that the most attractive and interesting feature (A and I of the AIDA principle) is the smiles on the faces of people used in the texts, that is Figures 1, 2, 4, 5, 6, 7, 8, 9, 10, 11, 12,
13 and 14. On the posters and billboards that have been used in this study, it has been used as
80 a symbol of joyfulness to attract the target audience to the messages. The outline of almost all the posters and billboards used in this study have conformed to the AIDA principle except the billboard used in figure 3.
5.4 How foregrounding was used in healthcare communication discourses
The study has shown that most of the posters and billboards used in this study have used capital letters to mark the words that the writer wants to stick in the readers’ minds after reading or to mark the important ones (figures 1, 2, 5, 6, 8,10,11,12, and 13). In some cases, capital letters were used in headings to make a distinction between the body of the text and the main idea/heading (figure 3). Other posters or billboards used small letters throughout for them to be unique and attain special attention from the readers because they look different, for example figure 7, 9 and 14. Other features, such as the use of different bright colours, especially in figure
11, was to direct the reader’s eye to what the writer perceive to be important.
5.5 Words pertaining affective stylistics
Figures 5 and 8 have employed words with strong affective connotation which persuade potential audience to conform to the required health practices. Judging from the afore- mentioned figures, it could be believed that some words that are used in healthcare communication discourses are those with strong affective and persuasive connotation. Such words were used in some texts to affect the readers’ emotions which contributes to changing their minds. Conclusion is drawn that writers use words pertaining to affective stylistics to a limited extent.
5.6 Conclusion
Primarily, this research desired to analyse posters and billboards used in healthcare communication by exposing some stylistics principle, for example foregrounding
(graphological deviation and pararelism), AIDA principle of advertisement and affective stylistics. The study also aimed to find out why billboards and posters writers and/or designers
81 use certain words and pictures to make sure that their messages are persuasive enough. The words that were used in healthcare communication discourses are carefully selected and well thought-out to ensure that they grasp the reader’s full attention to the message. In some cases, writers make use of the words that have strong affective connotation to win the emotions and hearts of the readers, and to inform them that the writer had them at heart when they composed particular texts. The study has revealed that designed messages and visuals used in selected healthcare communication discourses reflect the aspect of persuasion.
Furthermore, in most cases healthcare communication messages constitute most, if not all, the tactics that Gath (2010) has pinpointed to be used in adverts. In some texts (figures 3, 7 and 8), writers used digits instead of words to save up space, to ensure that the billboard/poster is not too much congested with words and to ensure that the message is as brief as possible. Writers also used memorable and attractive images to win the eyes and minds of the people coming across these texts. The AIDA principle of advertisement is used in most of the texts and it has been revealed that it is one of the persuasive tactics used in healthcare communication discourses which attract and persuade the potential audience to change their behaviours.
Moreover, the study concluded that in most cases if not all, healthcare communication texts employed graphological deviation to gain the full attention of the readers or onlookers, and to persuade them on the benefits of the given health practices. Billboards and posters used in the study have integrated various graphological deviation features such as punctuation, bold letters, decapitalisation, colours and indentation to influence readers to take action, see figure 1, 2, 5,
6, 7, 8, 9, 10, 11, 12, 13, 14 except figures 3 and 4. In figure 3, it is only the aspect of parallelism that was used. In rare cases, healthcare communication texts used famous people’s pictures such as in figure 6. Graphological deviation was the foregrounding technique used in most of
82 the messages except in figure 10, where dialectical deviation was used to enhance the better understanding of the message.
Some aspects such as dialectical deviation and indentation were rarely used in healthcare communication discourses. Dialectical deviation was only used in one message (11), and the principle that writers, or billboards, designers used mostly in their messages was foregrounding, specifically graphological deviation. In almost every poster or billboard, designers wrote words or have used pictures that appeared extra ordinary because of some features endorsed in them. Everything that was used that appeared to be different from what is considered normal was perceived that it drew attention to itself, which might result in getting the interest of the realities.
The study maintains from the data analysed that some elements of graphological deviation are minimally used in healthcare communication. One of these elements was indentation. It was only used in figure 2 with the intention of bringing de-atomisation in the message. The unfamiliar style that healthcare communication messages designers use (figure 2) is more persuasive than the style used in normal writing. Indentation contributes to the shape of healthcare messages on billboards. It then contributes to the unique appearance of words in the message and make the message look beautiful, which then arouse the reader’s desire for the healthcare product or service or contributed to the decision making of the target audience
All in all, the study has revealed that mostly, healthcare communication/promotion discourses are comprised of charming words such as personal pronouns, adjectives, comparatives, superlatives, graphological deviation, repetition, using pictures with attractive colours and other eye catching visuals, which influence the potential audience to do what is required from them.
83
5.7 Recommendations
Healthcare communication is an aspect of informing and persuading specific individuals and/or the target audiences about different significant health matters. When it comes to healthcare communication discourses on posters and billboards, messages should not necessarily abide to grammar rules, but should instead comprise of persuasive words that would win the readers/ onlookers’ attention and motivate them to adopt the required health behaviours. Billboards and posters designers should bear in mind at all times that all the eye catching words and visuals used in posters and billboards participate in the persuasiveness of texts.
In addition, all the words used in healthcare messages are essential in conveying the meaning, but certain words are more essential than others because they contribute more on the persuasiveness of the message. Therefore, words alongside pictures and visuals have to be skilfully and wisely selected to achieve the desired outcome of persuading readers/ onlookers.
However, there is still room for further research, especially in the Namibian context, with regards to how readers interpret the words/messages used in healthcare communication, as well as whether the same posters and/or billboards with the same message but written in different languages have the same persuasive powers. Future researchers could also consider doing a linguistic analysis of the words used in healthcare communication discourses. They might also consider looking at the register and slang used in healthcare communication discourses.
84
REFERENCES
Adegoju, A. (2008). A Rhetorical Analysis of the Discourse of Advertising Herbal
Medicine in Southwestern Nigeria. Linguistik Online 33 (1/80):1-16. Available at
http://www.linguistik-online.de/33_08/index.html. Accessed on 14/07/2018
Agency for Health Care Policy and Research. Evidence-based Practice Centers. (1997). (RFP
No. AHCPR-97-0001. Washington, DC: HHS.
Anthonissen, C., & Meyer, B. (2008). Question-answer sequences between doctors and
patients in a South African HIV/AIDS day clinic. Stellenbosch Papers in Linguistics,
36, 1-34.
Azuike, M. N. (2006). “Style and the Madman” The Anchor: Journal of General Studies, 1
(1) 77-82. Division of General Studies: University of Abuja.
Blaikie, N. (2000). Designing social research: The logic of anticipation. Massachusetts:
Blackwell.
Blanche, M. T., & Durrhein, K. (2014). Social constructionist methods. In M. T Blanche & K.
Durrheim (Eds). Research in practice (147-172). South Africa: University of Cape
Town Press.
Christelle, K. F. (2012). The translation of advertisements: Issues of semiotics, symbolism and
persuasion. Thesis (M.S)-Witwaterand University, Cape Town.
De Lima, D. (2014). The European Union’s approach to online behavioural advertising:
Protecting individuals or restricting business? Hong Kong: University of Hong Kong.
De Vos, A. S. (2002). Qualitative data analysis and interpretation. In Research and grass
roots: For the Social sciences and Human service profession. De Vos A.S., Strydom,
H., Fouche, C. B. & Deport, C. S. L., (Eds.). Pretoria: Van Schaik publishers. 339-355.
Durrheim, K. (1999). Research design. In M.T Blanche & K. Drrheim (Eds.), Research in
practice (pp. 29-53). South Africa: University of Cape Town Press.
85
Ekanjume, B. I. (2012). The impact of effective communication within family. Journal for
studies in Humanities and Social science, 2(1), 132.
Emodi, L. (2011). A semantic analysis of the language of advertising. An International
Multidisciplinary Journal, 5(4), 316-326.
Fish, S.E. (1970). What is stylistics and why are they saying such terrible things about it? In:
Freeman, D. ed. Essays in modern stylistics. London: Methuen, 53-57.
Gath, S. (2006). Propaganda and persuasion. California: Thousand oaks publishers.
Gibson, D. & Zhong, M. (2005). Intercultural communication competence in the healthcare
context. International Journal of Intercultural Relations. 29(2), 621-634.
Goddard, A. (1998). The language of advertising. London: Routledge.
Gregoriou, C. (2009). ‘Criminally minded: The stylistics of justification in contemporary
American crime fiction’. Style, 37(2), 144-59.
Grove, S. K., Burns, N. & Gray, J. R. (2013). The Practice of Nursing Research: Appraisal,
synthesis, and generation of evidence. 7th ed. St Louis, Missouri: Elsevier.
Kumar, R. (2005). Research methodology: A step by step guide for beginners. (2nd ed.).
London: SAGE publications Ltd.
Kangira, J. (2009). Product-oriented communication: A linguistic analysis of selected adverts.
Nawa journal of language and communication, 3(1), 39-45.
Kanj, M. & Mitic, W. (2009). Health literacy and health promotion: Definitions, concepts and
examples in the Eastern Mediterranean region. Working document for the discussion at
the 7th Global Conference on Health Promotion entitled “Promoting Health and
Development: Closing the Implementation Gap.” Nairobi, Kenya.
Kreps, G. L., Bonaguru, E. W., & Query, J. L. (1998). The history and development of the field
of health communication. In L. D. Jackson & B. K. Duffy (eds.) Health communication
research: Guide to developments and directions. Westport, C T: Greenwood Press.
86
Leech, G. & Short, M. (1981). Style in Fiction. A Linguistic Introduction to English
Fictional Prose. 2nd edition. Harlow: Pearson Longman.
Maibach, E., & Parrott, R. L. (1995). Designing Health Messages. Thousand Oaks, CA: Sage
Publications.
Makamani, R. (2017). An investigation into the efficacy of communication between health
workers and patients at selected healthcare centers in Windhoek. Journal of African
languages and language practice research in the 21st century, 5(2), 343-362.
Matamoros, D. C. (2011).The Role of Mass Media Communication in Public Health.
Spain: University of Almería. Retrieved from www.intechopen.com.
Mayr, A. (2010). Language and power. London, UK: Routledge.
Mlambo, N. (2017). Multilingualism in healthcare: Communicative experiences of expatriate
healthcare providers with varying linguistic repertoires in Windhoek, Namibia.
(Master thesis, University of Stellenbosch).
Mushaandja, J. (2007). Project work. Windhoek, Namibia: University of Namibia.
Ngara, E. (1982). Stylistic criticism and the African novel: A study of the language, art and
content of African fiction. London, Heineman.
Nnamdi-Eruchalu, G. I. (2015). An analysis of the linguistic features of billboard
advertising in Nigeria. Journal of Modern European Languages and Literatures, 4(1),
16-31.
Oyewo, Y. (2000). Human Communication. An Introduction. In Babajide, Adeyemi O.
(ed.): Studies in English Language. Ibadan: 149–167.
Parrott, R. (1999). Using coaches as role models of sun protection for youth: Georgia’s got
youth covered project. Journal of Applied Communication Research, 27(14), 107-119.
87
Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). London: Sage
publications.
Penn, C. (2007). Factors affecting the success of mediated medical interviews in South
Africa. Current Allergy and Clinical Immunology, 20(2), 66-72.
Ratzan, S. C. (1994). Health communication, challenges for the 21st century. ed. Special
issue.American Behavioral Scientist 38(2).
Rawal, P. (2013). AIDA marketing communication model: Stipulation a purchase decision in
the minds of the consumers through a linear progression of steps. IRC’s International
Journal of Multidisciplinary Research in Social & Management Sciences, 1(1), 37-
44. Retrieved from www.ircjournals.org.
Salomo, F. (2015). A discourse analysis of Metropolitan and Sanlam Namibia’s English
printadvertisements in the Namibian Newspapers: A comparative study. Windhoek,
Namibia: University of Namibia.
Simpson, P. (2004). Stylistics: A Resource Book for Students. London: Routledge.
Sindano, G. (2013). The rhetorical devices used in selected car advertisements in The
Namibian newspaper. Windhoek, Namibia: University of Namibia.
Sobane, K. & Anthonissen, C. (2013). Linguistic resources and strategies used in
multilingual communication in HIV/AIDS care centres in Lesotho. Stellenbosch Papers
in Linguistics, 41(3), 98-100.
Sobane, K. (2012). Multilingual practices and language scaling in behavioural change
communication on HIV/AIDS in Lesotho: The case of Phela health and development
communications. Stellenbosch Papers in Linguistics, 41(3), 109.
Smit, T. C. (2012). Approaches to stylistics analysis. Windhoek, Namibia:
University of Namibia.
Stewart, M. (2001). Towards a global definition of patient centred care. BMJ. 322, 444-445.
88
Wales, K. (2011). A dictionary of stylistics. 3rd ed. England: Pearson Education.
WHO (2005). Bangkok Charter for Health Promotion in a Globalized World.
Witte, K., & Morrison, K. (1995). Intercultural and cross-cultural health communication:
Understanding people and motivating healthy behaviors. In R. L. Wiseman (Ed.),
Intercultural communication theory (pp. 216-246). Newbury Park, CA: Sage.
Yeibo, E. (2014). Graphological foregrounding in Chimamanda Adichie’s Purple Hibiscus.
International Journal of language and linguistics. 1(2).
Yu, H. (2013). Language deviation in English advertising. Studies in Literature and Language,
7(2), 85-89.
Zuliana, N., Tanjung, F. & Ardi, H. (2010). An analysis of language style used in the slogan
of advertisement that found in the internet. Unpublished paper.
89